Healthcare Provider Details

I. General information

NPI: 1669687091
Provider Name (Legal Business Name): WARREN S STRAUSS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST SUITE 267
FREEHOLD NJ
07728-2537
US

IV. Provider business mailing address

695 US HIGHWAY 46 STE 400A
FAIRFIELD NJ
07004-1568
US

V. Phone/Fax

Practice location:
  • Phone: 732-333-8702
  • Fax: 732-333-8703
Mailing address:
  • Phone: 973-894-1265
  • Fax: 888-972-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001671
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMP134
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: