Healthcare Provider Details

I. General information

NPI: 1417063629
Provider Name (Legal Business Name): JOHN J VERDON JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 SYCAMORE AVE REAR
SHREWSBURY NJ
07702-4206
US

IV. Provider business mailing address

535 SYCAMORE AVE REAR
SHREWSBURY NJ
07702-4206
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-9468
  • Fax: 732-842-0666
Mailing address:
  • Phone: 732-842-9468
  • Fax: 732-842-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number24874
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN J VERDON JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 732-842-9468