Basic Information
| Provider Information | |||||||||
| NPI: | 1194944355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMBERT | ||||||||
| FirstName: | LONEVE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 WHITEHORSE HAMILTON SQUARE RD | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086903536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098902600 | ||||||||
| FaxNumber: | 6098900265 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 WHITEHORSE HAMILTON SQUARE RD | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086903536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098902600 | ||||||||
| FaxNumber: | 6098900265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00080400 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 25MP00080400 | 01 | NJ | LICENSE | OTHER |