Provider Demographics
NPI:1942322813
Name:WARREN MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:WARREN MEDICAL SERVICES, INC.
Other - Org Name:STATELINE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GAVORNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-387-0003
Mailing Address - Street 1:590 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2629
Mailing Address - Country:US
Mailing Address - Phone:908-387-0003
Mailing Address - Fax:908-387-0005
Practice Address - Street 1:590 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2629
Practice Address - Country:US
Practice Address - Phone:908-387-0003
Practice Address - Fax:908-387-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22481261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone