Provider Demographics
NPI:1003691304
Name:TABUCLIN, JIGGER
Entity Type:Individual
Prefix:MR
First Name:JIGGER
Middle Name:
Last Name:TABUCLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BROADHOLLOW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4833
Mailing Address - Country:US
Mailing Address - Phone:631-759-9692
Mailing Address - Fax:
Practice Address - Street 1:5409 100TH ST APT 411
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3778
Practice Address - Country:US
Practice Address - Phone:134-765-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664080-01163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health