Healthcare Provider Details

I. General information

NPI: 1841046059
Provider Name (Legal Business Name): MOHAWK VALLEY LACTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OXFORD XING STE 3
NEW HARTFORD NY
13413-3200
US

IV. Provider business mailing address

5 MARLBORO RD
NEW HARTFORD NY
13413-2012
US

V. Phone/Fax

Practice location:
  • Phone: 315-497-7080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNA MROCZEK
Title or Position: MEMBER/OWNER
Credential:
Phone: 315-725-2505