Healthcare Provider Details

I. General information

NPI: 1679847396
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY SUITE 106
PHILLIPSBURG NJ
08865-2748
US

IV. Provider business mailing address

10 BRASS CASTLE RD
WASHINGTON NJ
07882-6309
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-5221
  • Fax: 908-454-5228
Mailing address:
  • Phone: 908-835-1910
  • Fax: 908-835-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: GERARD J DELMONICO
Title or Position: PRESIDENT
Credential: MD
Phone: 908-859-6568