Willow Street Medical Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

2346 Issued in MA

Legal business name

WILLOW STREET MEDICAL LAB LLC

Doing business as

Willow Laboratories and Medical Center

Practice address

280 Union St
Lynn, MA 01901-1353

Phone

(781) 593-3480

NPI assigned

May 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gail B Marcus

Title

President Ceo

Phone

(781) 268-2400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willow Laboratories and Medical Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Whitney B Nowak, NP

  • Pediatric Nurse Practitioner
  • Epping, NH
  • NPI 1356318745
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360108800000",
    "number": "1740237304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 UNION ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019011353",
            "telephone_number": "781-268-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 UNION ST",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019011353",
            "telephone_number": "781-593-3480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW STREET MEDICAL LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2013-02-06",
        "status": "A",
        "authorized_official_last_name": "MARCUS",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "781-268-2400"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MA",
            "license": "2346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0805807",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Laboratories and Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Willett & Associates
• Clotyl Williams, M.D
• Seyrel Williams, L.I.C.S.W.
• Siddeeqah A Williams
• Willow Pharmacy
• Gretchen Willwerth, LICSW
• Mark Edward Wilner, DDS
• Claire Mary Wilson, M.S.W.
• Faith Jamille Wilson
• Grace R Wilson, RN

• Clinical Medical Laboratory in Lynn, MA
• Providers in Lynn, MA by specialty
• Clinical Medical Laboratory in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.