Healthcare Provider Details

I. General information

NPI: 1548223282
Provider Name (Legal Business Name): AMY E PEARDON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 BANGS AVE
ASBURY PARK NJ
07712-6902
US

IV. Provider business mailing address

516 BANGS AVE
ASBURY PARK NJ
07712-6902
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-0262
  • Fax: 732-775-8963
Mailing address:
  • Phone: 732-774-0262
  • Fax: 732-775-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB07560400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: