Provider Demographics
NPI:1366912420
Name:CAMDEN PREP, UNCOMMON SCHOOLS
Entity type:Organization
Organization Name:CAMDEN PREP, UNCOMMON SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-906-5592
Mailing Address - Street 1:263 WEST 38TH STREET
Mailing Address - Street 2:10TH FLOOR, WEST, UNCOMMON SCHOOLS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018
Mailing Address - Country:US
Mailing Address - Phone:646-774-2150
Mailing Address - Fax:
Practice Address - Street 1:1650 COPEWOOD ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3001
Practice Address - Country:US
Practice Address - Phone:856-605-5520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMDEN PREP, UNCOMMON SCHOOLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-03
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty