Healthcare Provider Details

I. General information

NPI: 1700417516
Provider Name (Legal Business Name): JARED WOLF RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 N OAKS BLVD
NORTH BRUNSWICK NJ
08902-2157
US

IV. Provider business mailing address

1307 N OAKS BLVD
NORTH BRUNSWICK NJ
08902-2157
US

V. Phone/Fax

Practice location:
  • Phone: 646-730-6262
  • Fax:
Mailing address:
  • Phone: 646-730-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15585700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR24129800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: