Provider Demographics
NPI:1477754547
Name:OATES, PETER JOHN (NP-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:OATES
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BERGEN STREET
Mailing Address - Street 2:SSB 8TH FLOOR, ROOM 822
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3001
Mailing Address - Country:US
Mailing Address - Phone:973-313-1035
Mailing Address - Fax:973-972-4263
Practice Address - Street 1:274 S ORANGE AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2419
Practice Address - Country:US
Practice Address - Phone:973-972-4150
Practice Address - Fax:973-972-4263
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05735500363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0318451Medicaid