Provider Demographics
NPI:1891940607
Name:OAK TREE PEDIATRICS
Entity Type:Organization
Organization Name:OAK TREE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-646-2020
Mailing Address - Street 1:1601 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1877
Mailing Address - Country:US
Mailing Address - Phone:609-646-2020
Mailing Address - Fax:609-484-8353
Practice Address - Street 1:1601 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1877
Practice Address - Country:US
Practice Address - Phone:609-646-2020
Practice Address - Fax:609-484-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04788700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
91001676201OtherAMERICHOICE
0822286001OtherAMERIHEALTH
NJ3433501Medicaid
NJP377671OtherOXFORD
NJ0010711OtherAETNA
NJ1056504OtherHORIZON NJ HEALTH