Provider Demographics
NPI:1720043409
Name:WILLOW MEDICAL
Entity Type:Organization
Organization Name:WILLOW MEDICAL
Other - Org Name:W. SCOTT TAYLOR MEDICAL & SURGICAL SUPPLIES
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:609-599-9371
Mailing Address - Street 1:940 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-3943
Mailing Address - Country:US
Mailing Address - Phone:609-599-9371
Mailing Address - Fax:609-599-2366
Practice Address - Street 1:940 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-3943
Practice Address - Country:US
Practice Address - Phone:609-599-9371
Practice Address - Fax:609-599-2366
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
NJ0089036Medicaid
NJ0089036Medicaid