Basic Information
| Provider Information | |||||||||
| NPI: | 1326445123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LUKE'S WARREN PHYSICIAN GROUP, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 ROSEBERRY ST | ||||||||
| Address2: | FARLEY BLDG. 2ND FLOOR | ||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088651690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088472621 | ||||||||
| FaxNumber: | 9088473045 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 ROSEBERRY ST | ||||||||
| Address2: | |||||||||
| City: | PHILLIPSBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088651690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083876018 | ||||||||
| FaxNumber: | 9088596813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 04/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | KROPG | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9088476568 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 04/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207RP1001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0678198 | 05 | NJ | MEDICAID |