Provider Demographics
NPI:1114921509
Name:WARREN MEDICENTER, P.A.
Entity Type:Organization
Organization Name:WARREN MEDICENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:B
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-240-2393
Mailing Address - Street 1:601 W UNION AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1166
Mailing Address - Country:US
Mailing Address - Phone:732-469-3627
Mailing Address - Fax:732-667-3708
Practice Address - Street 1:601 W UNION AVE
Practice Address - Street 2:STE 107
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1166
Practice Address - Country:US
Practice Address - Phone:732-469-3627
Practice Address - Fax:732-667-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0698360001OtherMEDICARE DME MAC
NJ0698360001OtherMEDICARE DME MAC