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General NPI Number Information
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NPI Number | 1053367334
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Entity Type | Organization
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Legal Business Name | MONTCLAIR BREAST CENTER PC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 37 NO FULLERTON AVENUE MONTCLAIR BREAST CENTER PC
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3426
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Country | US
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Telephone | 973-509-1818
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Fax | 973-509-0708
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Provider Business Mailing Address
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Address Line | 37 NO FULLERTON AVENUE MONTCLAIR BREAST CENTER PC
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3426
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Country | US
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Telephone | 973-509-1818
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Fax | 973-509-0708
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JACKIE L HERNANDEZ
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Credential |
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Telephone | 862-392-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | NJ
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