Provider Demographics
NPI:1710133236
Name:STUART L. JABLON, D.P.M.
Entity Type:Organization
Organization Name:STUART L. JABLON, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:L
Authorized Official - Last Name:JABLON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:1860-295-8791
Mailing Address - Street 1:9-B SOUTH MAIN STREET
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:186-029-5879
Mailing Address - Fax:186-029-5856
Practice Address - Street 1:9 S MAIN ST STE B
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:186-029-5879
Practice Address - Fax:186-029-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000458213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty