Provider Demographics
NPI:1346345212
Name:WARTENBERG, BRETT A (DC, PA)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:WARTENBERG
Suffix:
Gender:M
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8723
Mailing Address - Country:US
Mailing Address - Phone:609-654-0700
Mailing Address - Fax:
Practice Address - Street 1:13 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8723
Practice Address - Country:US
Practice Address - Phone:609-654-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00375900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT39104Medicare UPIN
NJ604133Medicare ID - Type Unspecified