Basic Information
| Provider Information | |||||||||
| NPI: | 1538364351 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ASSOCIATES OF MONTCLAIR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 HIGHLAND AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GLEN RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070281522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737489246 | ||||||||
| FaxNumber: | 9737488755 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 HIGHLAND AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GLEN RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070281522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737489246 | ||||||||
| FaxNumber: | 9737489246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOWENTHAL | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9737489246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA03239300 | NJ | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 25MA07449000 | NJ | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.