Healthcare Provider Details

I. General information

NPI: 1326319195
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 02/01/2018
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

755 MEMORIAL PKWY STE 102
PHILLIPSBURG NJ
08865-2774
US

V. Phone/Fax

Practice location:
  • Phone: 610-252-8281
  • Fax: 610-253-5321
Mailing address:
  • Phone: 484-503-8281
  • Fax: 833-816-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

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