Healthcare Provider Details

I. General information

NPI: 1649511510
Provider Name (Legal Business Name): JOAN D GREENBERG IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 ARGYLE RD
BROOKLYN NY
11230-2416
US

IV. Provider business mailing address

740 ARGYLE RD
BROOKLYN NY
11230-2416
US

V. Phone/Fax

Practice location:
  • Phone: 718-859-1855
  • Fax:
Mailing address:
  • Phone: 718-859-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number395460-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: