Provider Demographics
NPI:1497979132
Name:MONTCLAIR STATE UNIVERSITY HEALTH CENTER
Entity Type:Organization
Organization Name:MONTCLAIR STATE UNIVERSITY HEALTH CENTER
Other - Org Name:MONTCLAIR STATE UNIVERSITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FOR FINANCE AND TREA
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMONAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-655-5105
Mailing Address - Street 1:ONE NORMAL AVE
Mailing Address - Street 2:MONTCLAIR STATE UNIVERSITY HEALTH CENTER
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043
Mailing Address - Country:US
Mailing Address - Phone:974-655-4361
Mailing Address - Fax:973-655-4159
Practice Address - Street 1:ONE NORMAL AVE
Practice Address - Street 2:MONTCLAIR STATE UNIVERSITY HEALTH CENTER
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:974-655-4361
Practice Address - Fax:973-655-4159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTCLAIR STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health