Provider Demographics
NPI:1598987158
Name:GENOBLE, LEONORA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LEONORA
Middle Name:M
Last Name:GENOBLE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1308 MORRIS AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3328
Mailing Address - Country:US
Mailing Address - Phone:908-851-6767
Mailing Address - Fax:908-851-0382
Practice Address - Street 1:1308 MORRIS AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3328
Practice Address - Country:US
Practice Address - Phone:908-851-6767
Practice Address - Fax:908-851-0382
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00135300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant