Healthcare Provider Details

I. General information

NPI: 1295170140
Provider Name (Legal Business Name): CENTRAL JERSEY ARTS CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 SOUTH AVE
PLAINFIELD NJ
07062-1919
US

IV. Provider business mailing address

1225 SOUTH AVE
PLAINFIELD NJ
07062-1919
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-0030
  • Fax: 908-753-0331
Mailing address:
  • Phone: 908-753-0030
  • Fax: 908-753-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. ALISA OLIN
Title or Position: SPECIAL STUDENT POPULATION MANAGER
Credential: BME OTR/L SUPERVISOR
Phone: 908-753-0030