Provider Demographics
NPI:1447255583
Name:CHURGIN, WARREN K (MD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:K
Last Name:CHURGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 WYCKOFF RD
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1840
Mailing Address - Country:US
Mailing Address - Phone:732-544-9500
Mailing Address - Fax:732-544-0132
Practice Address - Street 1:158 WYCKOFF RD
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1840
Practice Address - Country:US
Practice Address - Phone:732-544-9500
Practice Address - Fax:732-544-0132
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04418300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJA61310Medicare UPIN
NJ606190BPLMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE