Healthcare Provider Details

I. General information

NPI: 1184977258
Provider Name (Legal Business Name): EDEN AUTISM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 OLD TRENTON RD
WEST WINDSOR NJ
08550-2411
US

IV. Provider business mailing address

2 MERWICK RD
PRINCETON NJ
08540-5730
US

V. Phone/Fax

Practice location:
  • Phone: 609-426-8656
  • Fax: 609-426-0630
Mailing address:
  • Phone: 609-987-0099
  • Fax: 609-987-0243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number03LO13R
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number03LO13R
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number03LO13R
License Number StateNJ

VIII. Authorized Official

Name: CAROL MARKOWITZ
Title or Position: CHIEF OPERATING OFFICER
Credential: M.A., M.ED
Phone: 609-987-0099