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General NPI Number Information
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NPI Number | 1699822700
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Entity Type | Organization
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Legal Business Name | MONTCLAIR PATHOLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 03/01/2011
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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 | 973-284-1104
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Fax | 973-284-6310
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Provider Business Mailing Address
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Address Line | PO BOX 110130
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City | NUTLEY
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State | NJ
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Zip | 07110-0903
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Country | US
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Telephone | 973-284-1104
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Fax | 973-284-6310
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN KIMLER
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Credential | M.D.
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Telephone | 973-284-1104
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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 | NJ
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