Provider Demographics
NPI:1003877267
Name:ABO, MARC NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:NEAL
Last Name:ABO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRASS CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-6309
Mailing Address - Country:US
Mailing Address - Phone:908-835-1910
Mailing Address - Fax:908-835-1924
Practice Address - Street 1:100 COVENTRY DR
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1900
Practice Address - Country:US
Practice Address - Phone:908-859-0034
Practice Address - Fax:908-859-3918
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03612300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP611867OtherOXFORD
NJ3900908Medicaid
NJ1002804OtherHORIZON NJ HEALTH
NJ40126OtherAETNA/US HEALTHCARE
PA5209956OtherKEYSTONE HEALTHPLANS
PA02321900OtherCAPITAL BLUE CROSS
NJ3900908Medicaid
PA5209956OtherKEYSTONE HEALTHPLANS
PA5209956OtherKEYSTONE HEALTHPLANS