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General NPI Number Information
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NPI Number | 1871684407
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Entity Type | Organization
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Legal Business Name | MONTCLAIR ENDOCRINE ASSOCIATES
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 119 GROVE ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4044
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Country | US
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Telephone | 973-744-3733
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Fax | 973-744-6996
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Provider Business Mailing Address
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Address Line | PO BOX 43545
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City | UPPER MONTCLAIR
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State | NJ
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Zip | 07043-0545
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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 | PARTNER
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Name | MARIS R DAVIS
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Credential | M.D.
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Telephone | 973-744-3733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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