Healthcare Provider Details

I. General information

NPI: 1801162631
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY BLDG 200, SUITE 201
PHILLIPSBURG NJ
08865-2748
US

IV. Provider business mailing address

755 MEMORIAL PKWY BLDG SUITE201
PHILLIPSBURG NJ
08865-2748
US

V. Phone/Fax

Practice location:
  • Phone: 908-859-8884
  • Fax: 908-859-6841
Mailing address:
  • Phone: 908-847-8884
  • Fax: 833-204-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE THOMAS
Title or Position: OWNER
Credential:
Phone: 908-847-2621