Provider Demographics
NPI:1285974154
Name:THE FAMILY CENTER AT MONTCLAIR
Entity type:Organization
Organization Name:THE FAMILY CENTER AT MONTCLAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-857-5333
Mailing Address - Street 1:155 POMPTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2942
Mailing Address - Country:US
Mailing Address - Phone:973-857-5333
Mailing Address - Fax:973-857-5338
Practice Address - Street 1:155 POMPTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2942
Practice Address - Country:US
Practice Address - Phone:973-857-5333
Practice Address - Fax:973-857-5338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE FAMILY CENTER AT MONTCLAIR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA083283002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty