Provider Demographics
NPI:1164852828
Name:PABLO, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PABLO
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 1:5211 BRISTOL STATION CT
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-3166
Mailing Address - Country:US
Mailing Address - Phone:917-971-7866
Mailing Address - Fax:
Practice Address - Street 1:5211 BRISTOL STATION CT
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-3166
Practice Address - Country:US
Practice Address - Phone:917-971-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626320163W00000X
NJ26NR16844900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse