Healthcare Provider Details

I. General information

NPI: 1609611672
Provider Name (Legal Business Name): ZOE MARIE DEAKYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date: 10/29/2025
Reactivation Date: 12/15/2025

III. Provider practice location address

65 W JIMMIE LEEDS RD
POMONA NJ
08240-9102
US

IV. Provider business mailing address

1101 LUDLOW ST APT 803
PHILADELPHIA PA
19107-4261
US

V. Phone/Fax

Practice location:
  • Phone: 609-661-3486
  • Fax:
Mailing address:
  • Phone: 609-661-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00976200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: