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General NPI Number Information
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NPI Number | 1548606783
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Entity Type | Individual
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Provider Name | JOHNATHON CLINTON LEBARON D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3 CENTURY DR
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City | PARSIPPANY
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State | NJ
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Zip | 07054-4610
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Country | US
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Telephone | 860-377-9780
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Fax |
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Provider Business Mailing Address
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Address Line | 401 S ATLANTIC AVE E APT 24A
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City | STRATFORD
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State | NJ
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Zip | 08084-1532
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Country | US
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Telephone | 860-377-9780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MB10063600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 283727
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License Number State | NY
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