Provider Demographics
NPI:1740794700
Name:JEANTY-EDMOND, LYNDA M
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:JEANTY-EDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:JEANTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19 TEMPLE LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3705
Mailing Address - Country:US
Mailing Address - Phone:609-401-7996
Mailing Address - Fax:609-614-6188
Practice Address - Street 1:19 TEMPLE LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3705
Practice Address - Country:US
Practice Address - Phone:609-401-7996
Practice Address - Fax:609-614-6188
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator