Provider Demographics
NPI:1417996604
Name:PEARDON, NATHANIEL A (DO)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:A
Last Name:PEARDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5220
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-5220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2080 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1031
Practice Address - Country:US
Practice Address - Phone:732-671-5777
Practice Address - Fax:732-671-3230
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07585100208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00259537OtherRAILROAD MEDICARE
2399317OtherUNITED HEALTHCARE
7579224OtherCIGNA
3768497OtherAETNA
P3598213OtherOXFORD
NJ342024631OtherHORIZON BCBS
7579224OtherCIGNA
NJ070484Medicare ID - Type Unspecified