Healthcare Provider Details

I. General information

NPI: 1114261146
Provider Name (Legal Business Name): MEREDITH LICHTENBERG IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 BANK ST APT 4A
NEW YORK NY
10014-2020
US

IV. Provider business mailing address

148 BANK ST APT 4A
NEW YORK NY
10014-2020
US

V. Phone/Fax

Practice location:
  • Phone: 212-929-1355
  • Fax:
Mailing address:
  • Phone: 212-929-1355
  • 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: