Provider Demographics
NPI:1932168283
Name:WARREN, PETER JON (MPT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JON
Last Name:WARREN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:1465 STATE HIGHWAY 31
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801
Practice Address - Country:US
Practice Address - Phone:908-328-3300
Practice Address - Fax:908-328-3268
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA09688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
316676Medicare ID - Type Unspecified