Provider Demographics
NPI:1780001354
Name:MONTCLAIR ANESTHESIA GROUP
Entity Type:Organization
Organization Name:MONTCLAIR ANESTHESIA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:CAMPANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-746-1500
Mailing Address - Street 1:393 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3741
Mailing Address - Country:US
Mailing Address - Phone:973-746-1500
Mailing Address - Fax:973-746-0955
Practice Address - Street 1:393 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3741
Practice Address - Country:US
Practice Address - Phone:973-746-1500
Practice Address - Fax:973-746-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty