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General NPI Number Information
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NPI Number | 1417467325
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Entity Type | Organization
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Legal Business Name | OAKLAND PRIMARY CARE
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 19 YAWPO AVE STE 1
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City | OAKLAND
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State | NJ
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Zip | 07436-2739
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Country | US
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Telephone | 973-270-6246
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Fax | 201-644-7315
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Provider Business Mailing Address
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Address Line | 19 YAWPO AVE STE 1
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City | OAKLAND
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State | NJ
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Zip | 07436-2739
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Country | US
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Telephone | 973-270-6246
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Fax | 201-644-7315
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT DELAGENTE
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Credential | DO
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Telephone | 973-270-6246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PENDING
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License Number State | NJ
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