Healthcare Provider Details

I. General information

NPI: 1760248694
Provider Name (Legal Business Name): ASHER YABLOK CM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FREDERICK PL
BERGENFIELD NJ
07621-4104
US

IV. Provider business mailing address

19 FREDERICK PL
BERGENFIELD NJ
07621-4104
US

V. Phone/Fax

Practice location:
  • Phone: 516-510-2436
  • Fax:
Mailing address:
  • Phone: 516-510-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: