Provider Demographics
NPI:1366463028
Name:WARNER, ROGER SETH (MD)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:SETH
Last Name:WARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4609
Mailing Address - Country:US
Mailing Address - Phone:212-686-1140
Mailing Address - Fax:212-213-0516
Practice Address - Street 1:120 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4609
Practice Address - Country:US
Practice Address - Phone:212-686-1140
Practice Address - Fax:212-213-0516
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112061208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00202479Medicaid
289891Medicare ID - Type Unspecified
NY00202479Medicaid