Healthcare Provider Details

I. General information

NPI: 1700201332
Provider Name (Legal Business Name): MALKA WELDLER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 03/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S LAKE DR
LAKEWOOD NJ
08701-3163
US

IV. Provider business mailing address

210 S LAKE DR
LAKEWOOD NJ
08701-3163
US

V. Phone/Fax

Practice location:
  • Phone: 718-916-2437
  • Fax:
Mailing address:
  • Phone: 718-916-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: