Provider Demographics
NPI:1548223282
Name:PEARDON, AMY E (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:PEARDON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 BANGS AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-6902
Mailing Address - Country:US
Mailing Address - Phone:732-774-0262
Mailing Address - Fax:732-775-8963
Practice Address - Street 1:516 BANGS AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6902
Practice Address - Country:US
Practice Address - Phone:732-774-0262
Practice Address - Fax:732-775-8963
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07560400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0093360Medicaid
NJ109530UWHMedicare PIN