Provider Demographics
NPI:1841803434
Name:ROBERT SABLJAK
Entity Type:Organization
Organization Name:ROBERT SABLJAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SABLJAK
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:386-426-1290
Mailing Address - Street 1:429 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7009
Mailing Address - Country:US
Mailing Address - Phone:386-426-1290
Mailing Address - Fax:386-426-1290
Practice Address - Street 1:429 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7009
Practice Address - Country:US
Practice Address - Phone:386-426-1290
Practice Address - Fax:386-426-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102475100Medicaid