Provider Demographics
NPI:1417063629
Name:JOHN J VERDON JR MD PA
Entity Type:Organization
Organization Name:JOHN J VERDON JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VERDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:732-842-9468
Mailing Address - Street 1:535 SYCAMORE AVE
Mailing Address - Street 2:REAR
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4206
Mailing Address - Country:US
Mailing Address - Phone:732-842-9468
Mailing Address - Fax:732-842-0666
Practice Address - Street 1:535 SYCAMORE AVE
Practice Address - Street 2:REAR
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4206
Practice Address - Country:US
Practice Address - Phone:732-842-9468
Practice Address - Fax:732-842-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ248742084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJVE451010Medicare ID - Type Unspecified
NJE55037Medicare UPIN