Provider Demographics
NPI:1518039056
Name:INSPIRA MEDICAL CENTER WOODBURY INC
Entity Type:Organization
Organization Name:INSPIRA MEDICAL CENTER WOODBURY INC
Other - Org Name:INSPIRA MEDICAL CENTER WOODBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VIERECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-853-2168
Mailing Address - Street 1:75 W RED BANK AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1694
Mailing Address - Country:US
Mailing Address - Phone:856-853-2055
Mailing Address - Fax:856-848-2879
Practice Address - Street 1:75 W RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1694
Practice Address - Country:US
Practice Address - Phone:856-853-2055
Practice Address - Fax:856-848-2879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3676102Medicaid
NJ3676102Medicaid