Provider Demographics
NPI:1558360222
Name:WARSHAUER, JEFFREY M (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:WARSHAUER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1450 ROUTE 22 WEST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092
Mailing Address - Country:US
Mailing Address - Phone:908-364-7801
Mailing Address - Fax:908-222-2757
Practice Address - Street 1:1450 ROUTE 22 WEST
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092
Practice Address - Country:US
Practice Address - Phone:908-364-7801
Practice Address - Fax:908-222-2757
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB55253207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6501001Medicaid
NJG01886Medicare UPIN
NJ633372ZM68Medicare PIN
NJ6501001Medicaid
NJ222279894OtherUNITED HEALTHCARE
NJG01886Medicare UPIN
NJ0501137OtherGHI
NJ222279894OtherBLUE SHIELD OF NJ
NJ5116015OtherAETNA