Provider Demographics
NPI:1891406674
Name:WARREN, MATTHEW (PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:WARREN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 TECUMSEH TRL
Mailing Address - Street 2:
Mailing Address - City:BROWNS MILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:08015-6158
Mailing Address - Country:US
Mailing Address - Phone:609-680-9275
Mailing Address - Fax:
Practice Address - Street 1:8025 BLACK HORSE PIKE STE 300
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2962
Practice Address - Country:US
Practice Address - Phone:833-823-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9533363A00000X
NJ25MP00762000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant