Healthcare Provider Details

I. General information

NPI: 1891713764
Provider Name (Legal Business Name): PRIORITY MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MORRIS TPKE STE 203
SHORT HILLS NJ
07078
US

IV. Provider business mailing address

748 MORRIS TPKE STE 203
SHORT HILLS NJ
07078-2617
US

V. Phone/Fax

Practice location:
  • Phone: 973-376-5077
  • Fax: 973-376-2615
Mailing address:
  • Phone: 973-376-5077
  • Fax: 973-376-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberHP0105800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL HUIZING
Title or Position: PRESIDENT
Credential:
Phone: 973-376-5077