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MONTCLAIR PEDIATRICS NPI 1073679932


NPI Information

NPI: 1073679932
Provider Name: MONTCLAIR PEDIATRICS
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 31D2093907

Address:
73 PARK ST
MONTCLAIR, NJ
ZIP 07042
Phone: (973) 746-7375
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MONTCLAIR PEDIATRICS is an adolescent medicine pediatrics in Montclair, NJ. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. MONTCLAIR PEDIATRICS NPI is 1073679932. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

73 PARK ST
MONTCLAIR, NJ
ZIP 07042-903
Phone: (973) 746-7375
Fax: (973) 746-6772

The provider's authorized official is Edward D. Rigtrup .
The authorized official title is Owner and has the following contact phone number (973) 746-7375.

The CLIA number assigned to this NPI record is 31D2093907 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/28/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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