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General NPI Number Information
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NPI Number | 1669587267
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Entity Type | Organization
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Legal Business Name | WARREN SKIN CARE CENTER PA
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 755 MEMORIAL PKWY BLDG 204
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-2748
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Country | US
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Telephone | 908-387-1001
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Fax | 908-387-1195
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Provider Business Mailing Address
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Address Line | PO BOX 5118
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City | PHILLIPSBURG
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State | NJ
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Zip | 08865-2748
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Country | US
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Telephone | 908-387-1001
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Fax | 908-387-1195
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Authorized Official
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Title or Position | CEO
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Name | LIAN JIE LI
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Credential | MD
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Telephone | 908-387-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MA66021
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License Number State | NJ
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