Healthcare Provider Details

I. General information

NPI: 1871684407
Provider Name (Legal Business Name): MONTCLAIR ENDOCRINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 GROVE ST
MONTCLAIR NJ
07042-4044
US

IV. Provider business mailing address

PO BOX 43545
UPPER MONTCLAIR NJ
07043-0545
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-3733
  • Fax: 973-744-6996
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIS R DAVIS
Title or Position: PARTNER
Credential: M.D.
Phone: 973-744-3733