Provider Demographics
NPI:1528590205
Name:OAKS INTEGRATED CARE
Entity Type:Organization
Organization Name:OAKS INTEGRATED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:QINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-267-5928
Mailing Address - Street 1:770 WOODLANE RD
Mailing Address - Street 2:SUITE 63
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3804
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:609-267-3029
Practice Address - Street 1:314 E STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1810
Practice Address - Country:US
Practice Address - Phone:609-396-5944
Practice Address - Fax:609-267-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ402036605251S00000X
NJ2000597251S00000X
NJ402037104251S00000X
NJ402037204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8855234Medicaid