Provider Demographics
NPI:1972788255
Name:WARREN ALTWERGER
Entity Type:Organization
Organization Name:WARREN ALTWERGER
Other - Org Name:WARREN ALTWERGER DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTWERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-565-3331
Mailing Address - Street 1:450 GIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3116
Mailing Address - Country:US
Mailing Address - Phone:845-565-3331
Mailing Address - Fax:845-565-3351
Practice Address - Street 1:450 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3116
Practice Address - Country:US
Practice Address - Phone:845-565-3331
Practice Address - Fax:845-565-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN2928213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5441040002Medicare NSC