Healthcare Provider Details

I. General information

NPI: 1366912420
Provider Name (Legal Business Name): CAMDEN PREP, UNCOMMON SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COPEWOOD ST
CAMDEN NJ
08103-3001
US

IV. Provider business mailing address

263 WEST 38TH STREET 10TH FLOOR, WEST, UNCOMMON SCHOOLS
NEW YORK NY
10018
US

V. Phone/Fax

Practice location:
  • Phone: 856-605-5520
  • Fax:
Mailing address:
  • Phone: 646-774-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. PHIL GARTENBERG
Title or Position: INTERIM CFO
Credential:
Phone: 201-906-5592