1417063629 NPI number — JOHN J VERDON JR MD PA

Table of content: (NPI 1417063629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417063629 NPI number — JOHN J VERDON JR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN J VERDON JR MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417063629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 SYCAMORE AVE
Provider Second Line Business Mailing Address:
REAR
Provider Business Mailing Address City Name:
SHREWSBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07702-4206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-842-9468
Provider Business Mailing Address Fax Number:
732-842-0666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 SYCAMORE AVE
Provider Second Line Business Practice Location Address:
REAR
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07702-4206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-842-9468
Provider Business Practice Location Address Fax Number:
732-842-0666
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VERDON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-842-9468

Provider Taxonomy Codes

  • Taxonomy code: 2084P0802X , with the licence number:  24874 , 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)





Copyright © 2007-2025 www.npivalidator.com