Healthcare Provider Details

I. General information

NPI: 1609010537
Provider Name (Legal Business Name): SHIRLEY K KABLAN N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 PUTNAM AVE
BROOKLYN NY
11221-2817
US

IV. Provider business mailing address

837 PUTNAM AVE
BROOKLYN NY
11221-2817
US

V. Phone/Fax

Practice location:
  • Phone: 718-602-4188
  • Fax: 718-602-4124
Mailing address:
  • Phone: 917-365-4948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420510-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001637-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: