Provider Demographics
NPI:1457316994
Name:JABLON, STUART L (DPM)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:L
Last Name:JABLON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1554
Mailing Address - Country:US
Mailing Address - Phone:860-295-8791
Mailing Address - Fax:860-295-8568
Practice Address - Street 1:9 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1554
Practice Address - Country:US
Practice Address - Phone:860-295-8791
Practice Address - Fax:860-295-8568
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000458213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4123832Medicaid
CTU12332Medicare UPIN