Provider Demographics
NPI:1497033690
Name:JABLINSKI, LAURA MARIE (IDC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:JABLINSKI
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 REED AVE
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1618
Mailing Address - Country:US
Mailing Address - Phone:240-274-5740
Mailing Address - Fax:
Practice Address - Street 1:29 REED AVE
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1618
Practice Address - Country:US
Practice Address - Phone:240-274-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman