Provider Demographics
NPI:1770927733
Name:SABLJAK, ROBERT (AP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SABLJAK
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL612195300OtherOFFICE OF WORKER'S COMPENSATION PROGRAMS (OWCP)
FLC0256OtherFLORIDA BLUE CROSS AND BLUE SHIELD