Healthcare Provider Details

I. General information

NPI: 1184433500
Provider Name (Legal Business Name): CAITLIN N ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 RAMAPO VALLEY RD
OAKLAND NJ
07436-2711
US

IV. Provider business mailing address

509 SUMMIT AVE
FRANKLIN LAKES NJ
07417-1805
US

V. Phone/Fax

Practice location:
  • Phone: 201-651-9100
  • Fax:
Mailing address:
  • Phone: 862-200-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09250300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: