Provider Demographics
NPI:1528328762
Name:MONTCLAIR STATE UNIVERSITY
Entity type:Organization
Organization Name:MONTCLAIR STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:MONTCLAIR STATE UNIVERSITY
Mailing Address - Street 2:1 NORMAL AVE.
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1624
Mailing Address - Country:US
Mailing Address - Phone:973-655-6685
Mailing Address - Fax:973-655-5376
Practice Address - Street 1:MONTCLAIR STATE UNIVERSITY
Practice Address - Street 2:14 NORMAL AVE.
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1624
Practice Address - Country:US
Practice Address - Phone:973-655-6685
Practice Address - Fax:973-655-5376
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTCLAIR STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-22
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00440900251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health