1417996604 NPI number — NATHANIEL A PEARDON D.O.

Table of content: DR. AVINASH DILIPKUMAR BHATIA (NPI 1790273175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417996604 NPI number — NATHANIEL A PEARDON D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARDON
Provider First Name:
NATHANIEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417996604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08754-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2080 HIGHWAY 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLMDEL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07733-1031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-671-5777
Provider Business Practice Location Address Fax Number:
732-671-3230
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  25MB07585100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00259537 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2399317 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7579224 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3768497 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3598213 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 342024631 . This is a "HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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