Provider Demographics
NPI:1518185743
Name:TAYLOR, WARREN IRVING (DO)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:IRVING
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ALPHA AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1049
Mailing Address - Country:US
Mailing Address - Phone:856-616-8836
Mailing Address - Fax:856-427-6181
Practice Address - Street 1:228 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:856-616-8836
Practice Address - Fax:856-427-6181
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05416300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5493200Medicaid