Healthcare Provider Details

I. General information

NPI: 1407240856
Provider Name (Legal Business Name): YONIE LEBLANC P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YONIE EDOUARD

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 EAST AVE FL 2
WOODSTOWN NJ
08098-1417
US

IV. Provider business mailing address

66 EAST AVE FL 2
WOODSTOWN NJ
08098-1417
US

V. Phone/Fax

Practice location:
  • Phone: 856-624-4319
  • Fax: 856-624-4329
Mailing address:
  • Phone: 856-935-1000
  • Fax: 856-935-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA058815
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018539
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00586000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: