Provider Demographics
NPI:1699426007
Name:JABLONKA PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:JABLONKA PLASTIC SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PLASTIC & RECONSTRUCTIVE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JABLONKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-734-1000
Mailing Address - Street 1:2829 SHORE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1498
Mailing Address - Country:US
Mailing Address - Phone:757-734-1000
Mailing Address - Fax:757-734-1001
Practice Address - Street 1:2829 SHORE DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1498
Practice Address - Country:US
Practice Address - Phone:757-734-1000
Practice Address - Fax:757-734-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty