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General NPI Number Information
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NPI Number | 1710133236
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Entity Type | Organization
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Legal Business Name | STUART L. JABLON, D.P.M.
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 9 S MAIN ST STE B
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1554
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Country | US
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Telephone | 186-029-5879
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Fax | 186-029-5856
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Provider Business Mailing Address
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Address Line | 9-B SOUTH MAIN STREET
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City | MARLBOROUGH
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State | CT
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Zip | 06447-1554
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Country | US
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Telephone | 186-029-5879
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Fax | 186-029-5856
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Authorized Official
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Title or Position | OWNER/PODIATRIST
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Name | STUART L JABLON
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Credential | D.P.M.
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Telephone | 18602958791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000458
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License Number State | CT
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