Healthcare Provider Details

I. General information

NPI: 1265356083
Provider Name (Legal Business Name): RED OAK WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W GRAND AVE STE 4
MONTVALE NJ
07645-2100
US

IV. Provider business mailing address

58 N NEW ARDMORE AVE
BROOMALL PA
19008-2608
US

V. Phone/Fax

Practice location:
  • Phone: 772-812-9652
  • Fax: 833-535-0164
Mailing address:
  • Phone: 772-812-9652
  • Fax: 833-535-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JARED TURNER
Title or Position: BILLING MANAGER
Credential:
Phone: 772-812-9652