Provider Demographics
NPI:1972761799
Name:POBLETE, HONESTO M (MD)
Entity type:Individual
Prefix:DR
First Name:HONESTO
Middle Name:M
Last Name:POBLETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4449
Mailing Address - Country:US
Mailing Address - Phone:609-658-4432
Mailing Address - Fax:
Practice Address - Street 1:3525 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1266
Practice Address - Country:US
Practice Address - Phone:609-570-2071
Practice Address - Fax:609-689-2614
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08589100363L00000X, 2086S0129X
NY245891208600000X
PAMD424921208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208600000XAllopathic & Osteopathic PhysiciansSurgery