Provider Demographics
NPI:1306507439
Name:WELL IN MONTCLAIR, LLC
Entity type:Organization
Organization Name:WELL IN MONTCLAIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, MSW
Authorized Official - Phone:917-375-4111
Mailing Address - Street 1:75 VALLEY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2210
Mailing Address - Country:US
Mailing Address - Phone:917-375-4111
Mailing Address - Fax:
Practice Address - Street 1:105 GROVE ST STE 17
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4053
Practice Address - Country:US
Practice Address - Phone:917-375-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty