Healthcare Provider Details

I. General information

NPI: 1508120593
Provider Name (Legal Business Name): BREASTFEEDING SUPPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W 95TH ST APT. 2C
NEW YORK NY
10025-6103
US

IV. Provider business mailing address

311 W 95TH ST APT. 2C
NEW YORK NY
10025-6103
US

V. Phone/Fax

Practice location:
  • Phone: 917-620-4068
  • Fax:
Mailing address:
  • Phone: 917-620-4068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10420788
License Number StateNY

VIII. Authorized Official

Name: MS. AYELET KAZNELSON
Title or Position: LACTATION CONSULTANT
Credential: CLC, IBCLC
Phone: 917-620-4068