Healthcare Provider Details

I. General information

NPI: 1780162396
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 COUNTY ROAD 519 STE 2
BELVIDERE NJ
07823
US

IV. Provider business mailing address

185 ROSEBERRY ST 2ND FLOOR FARLEY BLDG
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 908-847-3991
  • Fax: 833-541-5800
Mailing address:
  • Phone: 908-847-2621
  • Fax: 908-847-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE THOMAS
Title or Position: OWNER
Credential:
Phone: 908-847-6702