Healthcare Provider Details

I. General information

NPI: 1154795326
Provider Name (Legal Business Name): REBECCA JANE JABLONSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 BURDETT AVE
TROY NY
12180-2466
US

IV. Provider business mailing address

208 ROGGE RD
AMSTERDAM NY
12010-6925
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-8600
  • Fax:
Mailing address:
  • Phone: 518-774-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number553002
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number553002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: