Provider Demographics
NPI:1700657715
Name:SHABLAK, JONATHAN B (MSED)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
Last Name:SHABLAK
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CUMMING ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-4828
Mailing Address - Country:US
Mailing Address - Phone:917-319-5367
Mailing Address - Fax:
Practice Address - Street 1:19 CUMMING ST APT 2A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4828
Practice Address - Country:US
Practice Address - Phone:917-319-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst