Provider Demographics
NPI:1811367089
Name:AZU, NEBULON
Entity Type:Individual
Prefix:
First Name:NEBULON
Middle Name:
Last Name:AZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2930
Mailing Address - Country:US
Mailing Address - Phone:732-246-2220
Mailing Address - Fax:732-246-2220
Practice Address - Street 1:20 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2930
Practice Address - Country:US
Practice Address - Phone:732-246-2220
Practice Address - Fax:732-246-2220
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 343900000X, 347C00000X, 343800000X, 251C00000X, 347E00000X, 253Z00000X
NJA97615840008602172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347E00000XTransportation ServicesTransportation Broker
No253Z00000XAgenciesIn Home Supportive Care