Healthcare Provider Details

I. General information

NPI: 1437493665
Provider Name (Legal Business Name): HEATHER MCFADDEN, IBCLC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 W 121ST ST # 1
NEW YORK NY
10027-5901
US

IV. Provider business mailing address

523 W 121ST ST # 1
NEW YORK NY
10027-5901
US

V. Phone/Fax

Practice location:
  • Phone: 212-665-3899
  • Fax:
Mailing address:
  • Phone:
  • 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: HEATHER MCFADDEN
Title or Position: PRESIDENT
Credential:
Phone: 212-665-3899