Provider Demographics
NPI:1548203532
Name:NEBAB, VIRGILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIA
Middle Name:
Last Name:NEBAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STURBRIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5142
Mailing Address - Country:US
Mailing Address - Phone:732-463-0521
Mailing Address - Fax:
Practice Address - Street 1:31 STURBRIDGE DR E
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5142
Practice Address - Country:US
Practice Address - Phone:732-463-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03830500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223442277OtherTAX ID #
NJ5715487OtherGHI PPO #
NJP2039827OtherOXFORD #
NJ19280OtherUNIVERSITY HP #
NJ0812565OtherAETNA HMO #
NJMI000035901OtherAMERICHOICE #
NJ5999461OtherAETNA PPO #
NJ1042141OtherHORIZON NJ HEALTH #
NJ18414OtherAMERICAID #
NJ1K7505OtherHEALTHNET #
NJ551451OtherEMPIRE BC #
NJ6312608Medicaid