Provider Demographics
NPI:1497758940
Name:WARREN, ALAN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:WARREN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-0123
Mailing Address - Country:US
Mailing Address - Phone:973-809-5819
Mailing Address - Fax:908-879-2418
Practice Address - Street 1:221 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2528
Practice Address - Country:US
Practice Address - Phone:908-879-2818
Practice Address - Fax:908-879-2418
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00145900213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT27027Medicare UPIN
NJWA004086Medicare ID - Type Unspecified
NJ6480650001Medicare NSC