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General NPI Number Information
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NPI Number | 1578051116
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S WARREN PHYSICIAN GROUP, PC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 755 MEMORIAL PKWY STE 302
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-2771
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Country | US
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Telephone | 908-847-2621
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Fax | 908-847-3045
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Provider Business Mailing Address
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Address Line | 185 ROSEBERRY ST
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-1690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP OF MEDICAL AFFAIRS
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Name | JAMIE THOMAS
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Credential |
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Telephone | 908-847-2621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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