Provider Demographics
NPI:1881758571
Name:MARC NEAL ABO, MD PA
Entity type:Organization
Organization Name:MARC NEAL ABO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:ABO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-859-0034
Mailing Address - Street 1:100 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1900
Mailing Address - Country:US
Mailing Address - Phone:908-859-0034
Mailing Address - Fax:908-859-3918
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03612300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01000150400OtherAMERICHOICE
NJ1002804OtherHORIZON NJ HEALTH
NJ520995OtherAMERIHEALTH
NJP611867OtherOXFORD HEALTHPLANS
PA02321900OtherCAPITAL BLUE CROSS
NJ520995OtherKEYSTONE HEALTHPLANS EAST
NJJ2002887OtherCHAMPUS
PAP025324OtherCHAMPUS
NJ3900908Medicaid
NJ520995Medicare ID - Type Unspecified
PA02321900OtherCAPITAL BLUE CROSS
NJ3900908Medicaid
NJ442021759Medicare ID - Type UnspecifiedRAILROAD MEDICARE