Healthcare Provider Details

I. General information

NPI: 1972059558
Provider Name (Legal Business Name): STORK AND CRADLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E 86TH ST PEDIATRICS OF NEW YORK
NEW YORK NY
10028-0501
US

IV. Provider business mailing address

P.O. BOX 2509
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 646-627-7334
  • Fax: 646-627-7334
Mailing address:
  • Phone: 646-627-7334
  • Fax: 627-627-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number22 497346
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-20236
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33 337605
License Number StateNY

VIII. Authorized Official

Name: TAMARA HAWKINS
Title or Position: PRESIDENT
Credential: NP
Phone: 646-627-7334