NPIMap

Organization Active NPI

Montclair Hospital LLC

  • Primary Care Clinic/Center
  • Verona, NJ
National Provider Identifier
1295983484
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
10766 Issued in NJ
Legal business name
MONTCLAIR HOSPITAL LLC
Practice address
799 Bloomfield Ave
Suite 201
Verona, NJ 07044-1367
Phone
(973) 746-7050
Fax
(973) 857-2831
NPI assigned
Sep 3, 2008
Organization subpart
Yes
Parent organization
MONTCLAIR HOSPITAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joe Johnson
Title
Vice President
Phone
(866) 465-9222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 10766 NJ Primary

Addresses

Primary practice location

799 Bloomfield Ave
Suite 201
Verona, NJ 07044-1367

Mailing address

799 Bloomfield Ave
Suite 201
Verona, NJ 07044

Other identifiers 1

IdentifierTypeStateIssuer
10766OtherNJSTATE LICENSE NUMBER

Other names 1

  • Mountainside Family Practice Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090415000494 NJ Part B Supplier - Hospital Department(S) 7810092814 Receives reassigned benefits from 8 practitioners
Practice locations: Verona, NJ

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mountainside Hospital7 organizations share this tax ID, including this one
Part of
Mountainside Hospital

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

799 Bloomfield Ave
#2
Verona, NJ 07044

799 Bloomfield Ave
Ste 210
Verona, NJ 07044
Phone (973) 746-7050

799 Bloomfield Ave
Fl 2
Verona, NJ 07044
Phone (973) 259-3563

7 Ryerson Ave
West Caldwell, NJ 07006
Phone (973) 226-1577

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1295983484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "799 BLOOMFIELD AVE",
            "address_2": "SUITE 201",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "07044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 BLOOMFIELD AVE",
            "address_2": "SUITE 201",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070441367",
            "telephone_number": "973-746-7050",
            "fax_number": "973-857-2831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLAIR HOSPITAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTCLAIR HOSPITAL LLC",
        "enumeration_date": "2008-09-03",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "866-465-9222"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "10766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "10766",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountainside Family Practice Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Verona, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.