Provider Demographics
NPI:1447562251
Name:GREENBLATT, JENNIFER CZAPLICKI (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CZAPLICKI
Last Name:GREENBLATT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:CZAPLICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6704 STERLING RIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2329
Mailing Address - Country:US
Mailing Address - Phone:281-737-2611
Mailing Address - Fax:
Practice Address - Street 1:6704 STERLING RIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382
Practice Address - Country:US
Practice Address - Phone:281-737-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018829207Q00000X
TXQ1154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341113402Medicaid