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General NPI Number Information
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NPI Number | 1720894371
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Entity Type | Organization
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Legal Business Name | EDEN GROUP HEALTH LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 418 BROADWAY STE N
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 201-788-9665
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Fax | 201-569-2433
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Provider Business Mailing Address
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Address Line | 418 BROADWAY STE N
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 201-788-9665
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Fax | 201-569-2433
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHERILL L LYM
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Credential |
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Telephone | 201-788-9665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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