Provider Demographics
NPI:1750961504
Name:PRUS, NELSON III (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:PRUS
Suffix:III
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 1:59A BEAGLE CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PILESGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-3028
Mailing Address - Country:US
Mailing Address - Phone:856-343-9997
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3995
Practice Address - Country:US
Practice Address - Phone:610-447-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program