Healthcare Provider Details

I. General information

NPI: 1053772608
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY STE 112
PHILLIPSBURG NJ
08865-2774
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 908-847-8862
  • Fax: 866-297-3758
Mailing address:
  • Phone: 908-847-8862
  • Fax: 866-297-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA KROPF
Title or Position: OWNER
Credential: DO
Phone: 908-847-6568