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General NPI Number Information
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NPI Number | 1093095184
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Entity Type | Organization
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Legal Business Name | MONTCLAIR HOSPITAL LLC
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 1 BAY AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4837
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Country | US
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Telephone | 973-429-6002
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 DALLAS PKWY SUITE 450
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City | PLANO
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State | TX
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Zip | 75093-4370
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | MR. JOE JOHNSON
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Credential |
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Telephone | 866-465-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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