Healthcare Provider Details

I. General information

NPI: 1477668325
Provider Name (Legal Business Name): INGRID P WARMUTH M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FRONT ST
ELMER NJ
08318
US

IV. Provider business mailing address

420 FRONT ST P.O. BOX 578,
ELMER NJ
08318-2177
US

V. Phone/Fax

Practice location:
  • Phone: 856-358-1500
  • Fax: 856-358-1117
Mailing address:
  • Phone: 856-358-1500
  • Fax: 856-358-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA06715200
License Number StateNJ

VIII. Authorized Official

Name: MRS. DEBBIE IANNUCCI
Title or Position: MNGR
Credential:
Phone: 856-358-1500