Healthcare Provider Details

I. General information

NPI: 1336405265
Provider Name (Legal Business Name): CONSTANCE SUE POND MS IN OT, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CLAREMONT AVE, #63
NEW YORK NY
10027
US

IV. Provider business mailing address

15 CLAREMONT AVE, #63
NEW YORK NY
10027
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-1347
  • Fax: 212-864-6184
Mailing address:
  • Phone: 212-932-1347
  • Fax: 212-864-6184

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: