Healthcare Provider Details

I. General information

NPI: 1285057810
Provider Name (Legal Business Name): STEPHEN M ABO D O LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAY AVE SUITE 1
MONTCLAIR NJ
07042-4837
US

IV. Provider business mailing address

713 GIRARD AVE
WESTFIELD NJ
07090-2309
US

V. Phone/Fax

Practice location:
  • Phone: 973-259-3555
  • Fax: 973-839-3653
Mailing address:
  • Phone: 973-839-1003
  • Fax: 973-839-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MB07545100
License Number StateNJ

VIII. Authorized Official

Name: STEPHEN M ABO
Title or Position: PRESIDENT
Credential: DO
Phone: 973-839-1003