Provider Demographics
NPI:1467647438
Name:BRUCE L WARSHAUER MD LLC
Entity Type:Organization
Organization Name:BRUCE L WARSHAUER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL SUE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-295-0100
Mailing Address - Street 1:2424 BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4335
Mailing Address - Country:US
Mailing Address - Phone:732-295-0100
Mailing Address - Fax:732-295-0741
Practice Address - Street 1:2424 BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-4335
Practice Address - Country:US
Practice Address - Phone:732-295-0100
Practice Address - Fax:732-295-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04024200261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3076105Medicaid
NJ3076105Medicaid
NJ084553Medicare PIN