Warren Medical Services, Inc.

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

License

22481 Issued in NJ

Legal business name

WARREN MEDICAL SERVICES, INC.

Doing business as

Stateline Medical

Practice address

590 Marshall St
Phillipsburg, NJ 08865-2629

Phone

(908) 387-0003

Fax

(908) 387-0005

NPI assigned

Apr 4, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gary David Gavornik

Title

Executive Director

Phone

(908) 387-0003

Specialties & licenses 1

Addresses

Other names 1

• Stateline Medical Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942322813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 MARSHALL ST",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652629",
            "telephone_number": "908-387-0003",
            "fax_number": "908-387-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MARSHALL ST",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652629",
            "telephone_number": "908-387-0003",
            "fax_number": "908-387-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GAVORNIK",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "908-387-0003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NJ",
            "license": "22481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stateline Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Warren Health Care Alliance PC (Edward J. Cumbo, DO)
• Warren Health Care Alliance, PC
• Warren Health Care Alliance, PC
• Warren Health Care Alliance, PC (Village Medical Center)
• Warren Hospital
• Warren OB-GYN Associates
• Warren Radiology Associates PA (Warren Radiolody Association PA)
• Warren Skin Care Center PA
• Laura A Warren, LCSW
• Kiyosha Watts, DO

• Methadone Clinic in Phillipsburg, NJ
• Providers in Phillipsburg, NJ by specialty
• Methadone Clinic in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.