Healthcare Provider Details

I. General information

NPI: 1255052163
Provider Name (Legal Business Name): HARTWYCK AT OAK TREE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2048 OAK TREE RD
EDISON NJ
08820-2012
US

IV. Provider business mailing address

2048 OAK TREE RD
EDISON NJ
08820-2012
US

V. Phone/Fax

Practice location:
  • Phone: 732-906-2100
  • Fax:
Mailing address:
  • Phone: 732-906-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0680168
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: CHERYL A RYAN
Title or Position: FINANCE MANAGER
Credential:
Phone: 732-321-7000