Healthcare Provider Details
I. General information
NPI: 1134465388
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/17/2012
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
755 MEMORIAL PKWY SUITE 300
PHILLIPSBURG NJ
08865-2748
US
IV. Provider business mailing address
755 MEMORIAL PKWY STE 300
PHILLIPSBURG NJ
08865-2748
US
V. Phone/Fax
- Phone: 908-454-6306
- Fax: 908-454-2289
- Phone: 908-454-6303
- Fax: 866-281-6023
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
GERARD
DELMONICO
Title or Position: PRESIDENT
Credential: MD
Phone: 908-859-6568