Healthcare Provider Details
I. General information
NPI: 1982015301
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/20/2014
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
755 MEMORIAL PKWY SUITE 102
PHILLIPSBURG NJ
08865-2748
US
IV. Provider business mailing address
755 MEMORIAL PKWY STE 102
PHILLIPSBURG NJ
08865-2774
US
V. Phone/Fax
- Phone: 610-252-2222
- Fax: 610-252-0223
- Phone: 908-847-8484
- Fax: 866-289-8937
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
GERARD
DELMONICO
Title or Position: OWNER
Credential: MD
Phone: 908-859-6568