Provider Demographics
NPI:1417370883
Name:OAKTREE FAMILY PRACTICE
Entity Type:Organization
Organization Name:OAKTREE FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-321-5100
Mailing Address - Street 1:173 ESSEX AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2281
Mailing Address - Country:US
Mailing Address - Phone:732-321-5100
Mailing Address - Fax:732-321-5252
Practice Address - Street 1:173 ESSEX AVE STE 101
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2281
Practice Address - Country:US
Practice Address - Phone:732-321-5100
Practice Address - Fax:732-321-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06391200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135374Medicare PIN