Healthcare Provider Details

I. General information

NPI: 1578051116
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY STE 302
PHILLIPSBURG NJ
08865-2771
US

IV. Provider business mailing address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

V. Phone/Fax

Practice location:
  • Phone: 908-847-2621
  • Fax: 908-847-3045
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE THOMAS
Title or Position: VP OF MEDICAL AFFAIRS
Credential:
Phone: 908-847-2621