Provider Demographics
NPI:1902053606
Name:ABUD, NANCY LEROUX (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LEROUX
Last Name:ABUD
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 1:67 PRIMERA
Mailing Address - Street 2:
Mailing Address - City:SANTO DOMINGO
Mailing Address - State:BELLA VISTA
Mailing Address - Zip Code:00000
Mailing Address - Country:DO
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-0000
Practice Address - Country:US
Practice Address - Phone:973-481-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03277700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSOCIAL SECURITY