Healthcare Provider Details

I. General information

NPI: 1841650348
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WALMART PLAZA
CLINTON NJ
08809
US

IV. Provider business mailing address

22 WALMART PLAZA
CLINTON NJ
08809
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax: 999-999-9999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN KEMMERER
Title or Position: MANAGER
Credential:
Phone: 484-526-2019