Healthcare Provider Details

I. General information

NPI: 1073951315
Provider Name (Legal Business Name): YONIT LAX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2013
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST STE 300
PHILADELPHIA PA
19107-4405
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 215-861-8800
  • Fax:
Mailing address:
  • Phone: 215-861-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD495989
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: