Provider Demographics
NPI:1205499860
Name:TABLAN, MAUREEN BLADEL (MSED, SAS)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:BLADEL
Last Name:TABLAN
Suffix:
Gender:F
Credentials:MSED, SAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 250TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2524
Mailing Address - Country:US
Mailing Address - Phone:718-706-7500
Mailing Address - Fax:718-706-9595
Practice Address - Street 1:3711 35TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11101-1524
Practice Address - Country:US
Practice Address - Phone:718-706-7500
Practice Address - Fax:718-706-9595
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXXXXX6897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist