Provider Demographics
NPI:1407240856
Name:LEBLANC, YONIE (PA)
Entity Type:Individual
Prefix:
First Name:YONIE
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:YONIE
Other - Middle Name:
Other - Last Name:EDOUARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 EAST AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1417
Mailing Address - Country:US
Mailing Address - Phone:856-935-1000
Mailing Address - Fax:856-935-1001
Practice Address - Street 1:66 EAST AVE FL 2
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1417
Practice Address - Country:US
Practice Address - Phone:856-624-4319
Practice Address - Fax:856-624-4329
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058815363A00000X
NY018539363A00000X
NJ25MP00586000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant