Provider Demographics
NPI:1477509792
Name:NATHANIEL A. PEARDON, D.O., LLC
Entity type:Organization
Organization Name:NATHANIEL A. PEARDON, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEARDON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-671-5777
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 HWY 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
070484Medicare ID - Type Unspecified