Active NPI
Edward Leo Reardon Jr., L.P.N.
- Licensed Practical Nurse
- Billerica, MA
National Provider Identifier
1063536225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 58456
- Practice address
- 17 McHugh Ave
Billerica, MA 01821-5941 - Phone
- (978) 667-5804
- NPI assigned
- Mar 16, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 58456 | MA | Primary |
Addresses
Primary practice location
17 McHugh Ave
Billerica, MA 01821-5941
Mailing address
17 McHugh Ave
Billerica, MA 01821-5941
Phone (978) 667-5804
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0711233 | Other | MA | INDEPENDENT NURSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58456 | MA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063536225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 MCHUGH AVE",
"city": "BILLERICA",
"state": "MA",
"postal_code": "018215941",
"telephone_number": "978-667-5804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 MCHUGH AVE",
"city": "BILLERICA",
"state": "MA",
"postal_code": "018215941",
"telephone_number": "978-667-5804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REARDON",
"first_name": "EDWARD",
"middle_name": "LEO",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "L.P.N.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "MA",
"license": "58456",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT NURSE",
"identifier": "0711233",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Billerica, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.