Healthcare Provider Details

I. General information

NPI: 1154238343
Provider Name (Legal Business Name): MASON WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 BARGAINTOWN RD UNIT 1
EGG HARBOR TOWNSHIP NJ
08234-9638
US

IV. Provider business mailing address

3324 BARGAINTOWN RD UNIT 1
EGG HARBOR TOWNSHIP NJ
08234-9638
US

V. Phone/Fax

Practice location:
  • Phone: 609-299-1544
  • Fax: 609-357-4077
Mailing address:
  • Phone: 609-299-1544
  • Fax: 609-357-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02444000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: