Basic Information
Provider Information
NPI: 1003877267
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABO
FirstName: MARC
MiddleName: NEAL
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10 BRASS CASTLE RD
Address2:  
City: WASHINGTON
State: NJ
PostalCode: 078826309
CountryCode: US
TelephoneNumber: 9088351910
FaxNumber: 9088351924
Practice Location
Address1: 100 COVENTRY DR
Address2:  
City: PHILLIPSBURG
State: NJ
PostalCode: 088651900
CountryCode: US
TelephoneNumber: 9088590034
FaxNumber: 9088593918
Other Information
ProviderEnumerationDate: 03/29/2006
LastUpdateDate: 02/13/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X25MA03612300NJY Other Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
P61186701NJOXFORDOTHER
390090805NJ MEDICAID
100280401NJHORIZON NJ HEALTHOTHER
4012601NJAETNA/US HEALTHCAREOTHER
520995601PAKEYSTONE HEALTHPLANSOTHER
0232190001PACAPITAL BLUE CROSSOTHER


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