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General NPI Number Information
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NPI Number | 1417370883
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Entity Type | Organization
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Legal Business Name | OAKTREE FAMILY PRACTICE
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 173 ESSEX AVE STE 101
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City | METUCHEN
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State | NJ
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Zip | 08840-2281
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Country | US
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Telephone | 732-321-5100
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Fax | 732-321-5252
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Provider Business Mailing Address
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Address Line | 173 ESSEX AVE STE 101
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City | METUCHEN
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State | NJ
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Zip | 08840-2281
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Country | US
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Telephone | 732-321-5100
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Fax | 732-321-5252
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TRACEY AHN
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Credential | D.O.
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Telephone | 732-321-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB06391200
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License Number State | NJ
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