Healthcare Provider Details

I. General information

NPI: 1659391506
Provider Name (Legal Business Name): GREGORY ROBERT WARDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

135 STOUTSBURG BLVD
PENNINGTON NJ
08534-3001
US

V. Phone/Fax

Practice location:
  • Phone: 760-464-6542
  • Fax:
Mailing address:
  • Phone: 760-464-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25IA13038900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: