Healthcare Provider Details

I. General information

NPI: 1396167771
Provider Name (Legal Business Name): LEIGH ANNE O'CONNOR IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2014
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 STUYVESANT OVAL 5B
NEW YORK NY
10009-2420
US

IV. Provider business mailing address

10 STUYVESANT OVAL 5B
NEW YORK NY
10009-2420
US

V. Phone/Fax

Practice location:
  • Phone: 917-596-3646
  • Fax:
Mailing address:
  • Phone: 917-596-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: