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General NPI Number Information
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NPI Number | 1518909928
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Entity Type | Organization
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Legal Business Name | PILGRIM MEDICAL CENTER INC.
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 393 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3505
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Country | US
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Telephone | 973-746-1500
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Fax | 973-746-0955
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Provider Business Mailing Address
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Address Line | 393 BLOOMFIELD AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3505
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Country | US
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Telephone | 973-746-1500
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Fax | 973-746-0955
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. NICHOLAS VINCENT CAMPANELLA
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Credential | MD
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Telephone | 973-746-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 70789A
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License Number State | NJ
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