Healthcare Provider Details

I. General information

NPI: 1174193601
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123B ROSEBERRY ST
PHILLIPSBURG NJ
08865-1629
US

IV. Provider business mailing address

185 ROSEBERRY ST FARLEY BLDG., 2ND FLOOR
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 908-847-8853
  • Fax:
Mailing address:
  • Phone: 908-847-2621
  • Fax: 908-847-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SUE CHIAVAROLI
Title or Position: SUPERVISOR
Credential:
Phone: 484-526-3569