=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174502462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGINALD BLABER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2006
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BRACE RD STE C4
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08034-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-470-9029
-----------------------------------------------------
Fax | 856-796-9391
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 WASHINGTON AVE
-----------------------------------------------------
City | HADDONFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08033-3323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 25MA06214500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------