Provider Demographics
NPI:1831253418
Name:WARNS, ELYSE A (MS, ATC)
Entity type:Individual
Prefix:MS
First Name:ELYSE
Middle Name:A
Last Name:WARNS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:NJ
Mailing Address - Zip Code:07934
Mailing Address - Country:US
Mailing Address - Phone:908-234-1611
Mailing Address - Fax:
Practice Address - Street 1:ST. BERNARD'S ROAD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:NJ
Practice Address - Zip Code:07934
Practice Address - Country:US
Practice Address - Phone:908-234-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00092400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist