Provider Demographics
NPI:1659613545
Name:HARLEY, EDWARD JAMES III (RN)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JAMES
Last Name:HARLEY
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2114
Mailing Address - Country:US
Mailing Address - Phone:201-362-3088
Mailing Address - Fax:
Practice Address - Street 1:20 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2114
Practice Address - Country:US
Practice Address - Phone:201-362-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16162600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse