MEDICARE: LABOMBARD LACTATION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1588247159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABOMBARD LACTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	2 GLENDALE AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-3107
Country	:	US
Telephone Number	:	315-224-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 GLENDALE AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-3107
Country	:	US
Telephone Number	:	315-224-4049
Fax Number	:

Authorized Official
Title or Position	:	LACTATION COUNSELOR
Name	:	REBECCA ELISE LABOMBARD
Credential	:
Telephone Number	:	315-224-3404

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	05/03/2021

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