Provider Demographics
NPI:1043247398
Name:POBLETE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:POBLETE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:POBLETE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-586-1313
Mailing Address - Street 1:1601 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3821
Mailing Address - Country:US
Mailing Address - Phone:609-586-1313
Mailing Address - Fax:609-584-9227
Practice Address - Street 1:1601 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3821
Practice Address - Country:US
Practice Address - Phone:609-586-1313
Practice Address - Fax:609-584-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28176208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2806606Medicaid
NJ2806606Medicaid