Healthcare Provider Details

I. General information

NPI: 1306070834
Provider Name (Legal Business Name): EPHRAIM TZIYON YABLOK MS, PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 VIRGINIA AVE
CLIFTON NJ
07012-1224
US

IV. Provider business mailing address

95 VIRGINIA AVE
CLIFTON NJ
07012-1224
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-0833
  • Fax:
Mailing address:
  • Phone: 973-777-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number024326-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: