Provider Demographics
NPI:1588753396
Name:WARREN, MICHELE (PT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SIMI CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3752
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2763
Practice Address - Country:US
Practice Address - Phone:856-424-4444
Practice Address - Fax:856-673-2589
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00388400174400000X
PAPT001674E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1412556OtherUNITEDHEALTHCARE MPIN
NJ147339OtherAMERIHEALTH
NJ2230040OtherFIRST HEALTH
NJ147339OtherAMERIHEALTH