Provider Demographics
NPI:1477668325
Name:INGRID P WARMUTH M D P A
Entity Type:Organization
Organization Name:INGRID P WARMUTH M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-358-1500
Mailing Address - Street 1:420 FRONT ST
Mailing Address - Street 2:P.O. BOX 578,
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-2177
Mailing Address - Country:US
Mailing Address - Phone:856-358-1500
Mailing Address - Fax:856-358-6985
Practice Address - Street 1:420 FRONT ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318
Practice Address - Country:US
Practice Address - Phone:856-358-1500
Practice Address - Fax:856-358-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06715200207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG74723Medicare UPIN
NJ012064Medicare ID - Type Unspecified