Provider Demographics
NPI:1790960821
Name:DR BRETT WARTENBERG PA
Entity Type:Organization
Organization Name:DR BRETT WARTENBERG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WUNSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-654-0700
Mailing Address - Street 1:13 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8723
Mailing Address - Country:US
Mailing Address - Phone:609-654-0700
Mailing Address - Fax:609-654-8384
Practice Address - Street 1:13 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8723
Practice Address - Country:US
Practice Address - Phone:609-654-0700
Practice Address - Fax:609-654-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC003759111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT39104Medicare UPIN
NJ604133Medicare PIN