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General NPI Number Information
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NPI Number | 1891406674
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Entity Type | Individual
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Provider Name | MATTHEW WARREN PA
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Gender | Male
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 03/11/2023
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Provider Practice Location Address
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Address Line | 8025 BLACK HORSE PIKE STE 300
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-2962
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Country | US
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Telephone | 833-823-6533
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Fax |
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Provider Business Mailing Address
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Address Line | 66 TECUMSEH TRL
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City | BROWNS MILLS
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State | NJ
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Zip | 08015-6158
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Country | US
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Telephone | 609-680-9275
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9533
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00762000
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License Number State | NJ
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