Healthcare Provider Details

I. General information

NPI: 1356477293
Provider Name (Legal Business Name): GERARDO YABLONOVICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 49TH ST
BROOKLYN NY
11219-3212
US

IV. Provider business mailing address

404 JONES RD
ENGLEWOOD NJ
07631-5001
US

V. Phone/Fax

Practice location:
  • Phone: 718-436-7750
  • Fax: 718-851-8557
Mailing address:
  • Phone: 201-569-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number038296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: