Healthcare Provider Details

I. General information

NPI: 1023746211
Provider Name (Legal Business Name): ST. LUKE'S WARREN PHYSICIAN GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

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