Provider Demographics
NPI:1699981712
Name:TOWNSHIP OF MONTCLAIR
Entity type:Organization
Organization Name:TOWNSHIP OF MONTCLAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MESSINEO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:973-509-4980
Mailing Address - Street 1:205 CLAREMONT AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3401
Mailing Address - Country:US
Mailing Address - Phone:973-509-4970
Mailing Address - Fax:973-509-1479
Practice Address - Street 1:205 CLAREMONT AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3401
Practice Address - Country:US
Practice Address - Phone:973-509-4970
Practice Address - Fax:973-509-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ758895Medicare PIN