STATELINE MEDICAL
NPI 1942322813
Clinic/Center - Methadone in Phillipsburg, NJ

NPI Status: Active since April 04, 2007

Contact Information

590 MARSHALL ST
PHILLIPSBURG, NJ
ZIP 08865
Phone: (908) 387-0003
Fax: (908) 387-0005

NPI Profile Information
Primary Taxonomy
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Clinic/Center
Methadone
CLIA Number: 31D2132661
CLIA Cert. Type: Other - ALCOHOL & DRUG TREATMENT
CLIA Exp. Date: 06-25-2027

About STATELINE MEDICAL

This page provides the complete NPI Profile along with additional information for Stateline Medical, a provider established in Phillipsburg, New Jersey operating as a Clinic/center, focusing in methadone . The healthcare provider is registered in the NPI registry with number 1942322813 assigned on April 2007. The practitioner's primary taxonomy code is 261QM2800X with license number 22481 (NJ). The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Stateline Medical. The authorized official of this NPI record is Mr. Gary David Gavornik (Executive Director)

NPI: 1942322813
Provider Legal Name: WARREN MEDICAL SERVICES, INC.
Other Organization Name: STATELINE MEDICAL
Other Name Type: Doing Business As (3)
Entity Type: Organization
Location Address: 590 MARSHALL ST PHILLIPSBURG, NJ 08865
Location Phone: (908) 387-0003
Location Fax: (908) 387-0005
Mailing Address: 590 MARSHALL ST PHILLIPSBURG, NJ 08865
Mailing Phone: (908) 387-0003
Mailing Fax: (908) 387-0005
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 04-04-2007
Last Update Date: 08-22-2020
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Clinic/Center Methadone
Taxonomy Code: 261QM2800X
Type: Ambulatory Health Care Facilities
License No.: 22481
License State: NJ
Taxonomy Description: An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: MR. GARY DAVID GAVORNIK
Authorized Official Title: EXECUTIVE DIRECTOR
Authorized Official Phone: (908) 387-0003

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 31D2132661
Facility Type: Other - ALCOHOL & DRUG TREATMENT
Certificate Effective Date: June 26, 2025
Certificate Expiration Date: June 25, 2027
Laboratory Director: CHRISTOPHER K. JOHNSTON
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Stateline Medical to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI NPI Number Validation

How NPI Validation Works

The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.

To verify the NPI 1942322813, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 67. The final step is to find the difference between that total and the next multiple of ten (70 - 67 = 3).

Digit-by-digit view

Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 8

Pos 4

Unchanged

Pos 5

Doubled → 6

Pos 6

Unchanged

Pos 7

Doubled → 4

Pos 8

Unchanged

Pos 9

Doubled → 2

Check

Target digit

Regular digit Doubled digit Check digit

Step 1: Double every other digit from the right

Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.

1 → 2 4 → 8 3 → 6 2 → 4 1 → 2

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 9 + 8 + 2 + 6 + 2 + 4 + 8 + 2 + 24 = 67

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 67 is 70. The difference is the calculated check digit.

70 - 67 = 3

This NPI is valid

The calculated check digit is 3, which matches the last digit of 1942322813.