Basic Information
Provider Information | |||||||||
NPI: | 1134163926 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | WARREN HEALTH CARE ALLIANCE, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10 BRASS CASTLE RD | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 078824327 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9088351910 | ||||||||
FaxNumber: | 9088351886 | ||||||||
Practice Location | |||||||||
Address1: | 755 MEMORIAL PKWY | ||||||||
Address2: |   | ||||||||
City: | PHILLIPSBURG | ||||||||
State: | NJ | ||||||||
PostalCode: | 088652748 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9084545221 | ||||||||
FaxNumber: | 9084545228 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2006 | ||||||||
LastUpdateDate: | 02/09/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DELMONICO | ||||||||
AuthorizedOfficialFirstName: | GERARD | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 9088596568 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
ID Information
ID | Type | State | Issuer | Description | CJ2448 | 01 | NJ | RAILROAD MEDICARE | OTHER | 6285708 | 05 | NJ |   | MEDICAID |