Provider Demographics
NPI:1699746818
Name:DEACON, NANCY S (DO)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:S
Last Name:DEACON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:600 MULE ROAD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-6460
Mailing Address - Country:US
Mailing Address - Phone:732-557-5555
Mailing Address - Fax:732-557-9555
Practice Address - Street 1:600 MULE ROAD
Practice Address - Street 2:SUITE 10
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-6460
Practice Address - Country:US
Practice Address - Phone:732-557-5555
Practice Address - Fax:732-557-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2014-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06229600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6836909Medicaid