Provider Demographics
NPI:1629264205
Name:DEBADON LLC
Entity Type:Organization
Organization Name:DEBADON LLC
Other - Org Name:NELSON'S SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:ASPLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-876-4935
Mailing Address - Street 1:2711 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-3316
Mailing Address - Country:US
Mailing Address - Phone:610-876-4935
Mailing Address - Fax:610-876-5940
Practice Address - Street 1:2711 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-3316
Practice Address - Country:US
Practice Address - Phone:610-876-4935
Practice Address - Fax:610-876-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD00914332S00000X
335E00000X
PA6000007099335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6033850001Medicare NSC