Edward Randall Faulkner, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

44SC05919000 Issued in NJ

Practice address

1985 State Route 34 Ste A3
Wall Township, NJ 07719-9101

Phone

(215) 817-7372

Fax

(215) 554-6966

NPI assigned

Oct 10, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, NJ2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2819/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jefferson University Physicians

  dba Jefferson GI

  • Gastroenterology Physician
  • Phila, PA
  • NPI 1205898723
  NPD (past)
• Jefferson University Physicians

  • General Practice Physician
  • Philadelphia, PA
  • NPI 1326093675
  NPD (past)
• Mazzoni Center

  • Social Worker
  • Philadelphia, PA
  • NPI 1225188428
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1790936599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 GRASSMERE AVE",
            "city": "INTERLAKEN",
            "state": "NJ",
            "postal_code": "077124313",
            "telephone_number": "215-817-7372",
            "fax_number": "215-554-6966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 STATE ROUTE 34 STE A3",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077199101",
            "telephone_number": "215-817-7372",
            "fax_number": "215-554-6966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1845 Walnut St Ste 653",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191034718",
            "country_code": "US",
            "telephone_number": "215-384-8624",
            "fax_number": "215-554-6966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAULKNER",
        "first_name": "EDWARD",
        "middle_name": "RANDALL",
        "name_prefix": "Mr.",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-10",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW126856",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NJ",
            "license": "44SC05919000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delaney Micaylah Duncan, PA
• Jaclyn Joanne Dunn, PT, DPT
• Ellie Kelsey Nutrition LLC
• Elsamadisi Psychiatry LLC
• Amir Elsamadisi, MD
• Joan Alys Ferrelli, APRN,BC
• Michael James Findura, D.O.
• Franklin J Frasco, M.D.
• Angela M Freeman, APN
• Nicole Frey

• Social Worker in Wall Township, NJ
• Providers in Wall Township, NJ by specialty
• Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.