Healthcare Provider Details

I. General information

NPI: 1558869222
Provider Name (Legal Business Name): DR. LENA EDWARDS ACADEMIC CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BRAMHALL AVE
JERSEY CITY NJ
07304-2730
US

IV. Provider business mailing address

509 BRAMHALL AVE
JERSEY CITY NJ
07304-2730
US

V. Phone/Fax

Practice location:
  • Phone: 201-433-5300
  • Fax:
Mailing address:
  • Phone: 201-433-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code364SS0200X
TaxonomySchool Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER GARLIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 201-433-5300