Provider Demographics
NPI:1205213824
Name:INSPIRA MEDICAL CENTER WOODBURY
Entity Type:Organization
Organization Name:INSPIRA MEDICAL CENTER WOODBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-845-0100
Mailing Address - Street 1:509 N BROAD ST
Mailing Address - Street 2:DOWNS BUILDING, SECOND FLOOR
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1617
Mailing Address - Country:US
Mailing Address - Phone:856-686-5632
Mailing Address - Fax:856-686-5119
Practice Address - Street 1:509 N BROAD ST
Practice Address - Street 2:DOWNS BUILDING, SECOND FLOOR
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1617
Practice Address - Country:US
Practice Address - Phone:856-686-5632
Practice Address - Fax:856-686-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05607300251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3676102Medicaid