Provider Demographics
NPI:1003286295
Name:JABLONOWSKA, MAGDA (LAC)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:
Last Name:JABLONOWSKA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 7TH AVE
Mailing Address - Street 2:116
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4315
Mailing Address - Country:US
Mailing Address - Phone:347-664-0649
Mailing Address - Fax:
Practice Address - Street 1:358 7TH AVE
Practice Address - Street 2:116
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4315
Practice Address - Country:US
Practice Address - Phone:347-664-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002542171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist