Provider Demographics
NPI:1831278373
Name:ALTWERGER, WARREN (DPM)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:ALTWERGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:845-465-3351
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:845-465-3351
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN2928213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP37222OtherEMPIRE BLUE CROSS BLUE SH
990109OtherMVP
104012OtherWELLCARE
NYPL6301OtherEMPIRE BLUE CROSS BLUE SH
P2810453OtherOXFORD
0083825OtherGHI
P2810453OtherOXFORD
990109OtherMVP
NYP37222OtherEMPIRE BLUE CROSS BLUE SH
T51123Medicare UPIN