Healthcare Provider Details

I. General information

NPI: 1730749615
Provider Name (Legal Business Name): LISA YANOWITZ CNM, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE
NEW YORK NY
10029-7494
US

IV. Provider business mailing address

111 4TH AVE APT 10O
NEW YORK NY
10003-5240
US

V. Phone/Fax

Practice location:
  • Phone: 917-428-5058
  • Fax:
Mailing address:
  • Phone: 917-428-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number633783-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number633783-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number633783-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number002229
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: