Healthcare Provider Details

I. General information

NPI: 1174502462
Provider Name (Legal Business Name): REGINALD BLABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD STE C4
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

220 WASHINGTON AVE
HADDONFIELD NJ
08033-3323
US

V. Phone/Fax

Practice location:
  • Phone: 856-470-9029
  • Fax: 856-796-9391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06214500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: