Healthcare Provider Details

I. General information

NPI: 1053037556
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY STE 115
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: 908-454-3737
  • Fax: 908-454-0402
Mailing address:
  • Phone: 908-847-2621
  • Fax: 908-847-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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