Provider Demographics
NPI:1457534489
Name:LEBLANC, BABETTE MICHELLE
Entity Type:Individual
Prefix:
First Name:BABETTE
Middle Name:MICHELLE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 DEERLAND RD
Mailing Address - Street 2:PO BOX 68
Mailing Address - City:LONG LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12847-0068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1419
Practice Address - Country:US
Practice Address - Phone:518-359-3378
Practice Address - Fax:518-359-9424
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00666711Medicaid