Provider Demographics
NPI:1598720286
Name:WILLOW MEDICAL
Entity Type:Organization
Organization Name:WILLOW MEDICAL
Other - Org Name:SHORE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:N/A
Authorized Official - Phone:609-653-6161
Mailing Address - Street 1:505 NEW RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2049
Mailing Address - Country:US
Mailing Address - Phone:609-653-6161
Mailing Address - Fax:609-653-9604
Practice Address - Street 1:505 NEW RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2049
Practice Address - Country:US
Practice Address - Phone:609-653-6161
Practice Address - Fax:609-653-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3620603Medicaid
NJ4784100003Medicare NSC