Provider Demographics
NPI:1902346877
Name:MONTCLAIR STATE UNIVERSITY
Entity Type:Organization
Organization Name:MONTCLAIR STATE UNIVERSITY
Other - Org Name:MONTCLAIR STATE CLINICAL SERVICES GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FOR FINANCE
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:973-655-7365
Mailing Address - Street 1:1 NORMAL AVENUE
Mailing Address - Street 2:DIVISION OF FINANCE
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043
Mailing Address - Country:US
Mailing Address - Phone:973-655-5105
Mailing Address - Fax:973-655-7643
Practice Address - Street 1:1 NORMAL AVENUE
Practice Address - Street 2:DIVISION OF FINANCE
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:973-655-5105
Practice Address - Fax:973-655-7643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center