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General NPI Number Information
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NPI Number | 1497979132
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Entity Type | Organization
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Legal Business Name | MONTCLAIR STATE UNIVERSITY HEALTH CENTER
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | ONE NORMAL AVE MONTCLAIR STATE UNIVERSITY HEALTH CENTER
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City | MONTCLAIR
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State | NJ
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Zip | 07043
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Country | US
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Telephone | 974-655-4361
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Fax | 973-655-4159
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Provider Business Mailing Address
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Address Line | ONE NORMAL AVE MONTCLAIR STATE UNIVERSITY HEALTH CENTER
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City | MONTCLAIR
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State | NJ
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Zip | 07043
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Country | US
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Telephone | 974-655-4361
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Fax | 973-655-4159
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Authorized Official
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Title or Position | VICE PRESIDENT FOR FINANCE AND TREA
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Name | MS. DONNA MCMONAGLE
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Credential |
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Telephone | 973-655-5105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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