Provider Demographics
NPI:1063551034
Name:POBLINER, JODI LYNNE
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:LYNNE
Last Name:POBLINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNNE
Other - Last Name:BLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 BROOKFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1410
Mailing Address - Country:US
Mailing Address - Phone:631-846-3304
Mailing Address - Fax:
Practice Address - Street 1:6 BROOKFIELD LN
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1410
Practice Address - Country:US
Practice Address - Phone:631-846-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008240-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist