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General NPI Number Information
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NPI Number | 1891940607
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Entity Type | Organization
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Legal Business Name | OAK TREE PEDIATRICS
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 1601 TILTON RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1877
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Country | US
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Telephone | 609-646-2020
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Fax | 609-484-8353
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Provider Business Mailing Address
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Address Line | 1601 TILTON RD
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1877
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Country | US
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Telephone | 609-646-2020
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Fax | 609-484-8353
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALBERT C. DEARDEN
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Credential | MD
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Telephone | 609-646-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 25MA04788700
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License Number State | NJ
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