Healthcare Provider Details

I. General information

NPI: 1497758940
Provider Name (Legal Business Name): ALAN M WARREN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAIN ST
CHESTER NJ
07930-2528
US

IV. Provider business mailing address

PO BOX 123
LAKE HIAWATHA NJ
07034-0123
US

V. Phone/Fax

Practice location:
  • Phone: 908-879-2818
  • Fax: 908-879-2418
Mailing address:
  • Phone: 973-809-5819
  • Fax: 908-879-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00145900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: