Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 25MD00188100 | NJ |
NPI | 1396782397 |
---|---|
Provider Name | Scott David Warren |
First Address | Cherry Hill, NJ 08034-3574 |
Second Address | Cherry Hill, NJ 08034-3574 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 28/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1086804 | (05) | NJ |
480032638 | RAILROAD MEDICARE (01) | NJ |
T88162 | (02) | NJ |