Individual
DR. PRUDENCIO G. TABLANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 CLARKSON AVE, BROOKLYN, NY 11203-2056
(718) 270-3126
(718) 270-3797
Mailing address
450 CLARKSON AVE, BOX 1262, BROOKLYN, NY 11203-2056
(718) 270-8867
(718) 270-1794
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
140870-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00786498
—
NY
Enumeration date
09/01/2005
Last updated
03/10/2015
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