Healthcare Provider Details

I. General information

NPI: 1376817742
Provider Name (Legal Business Name): YEKATERINA SPIVAK RPA-C, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WELSH RD
HUNTINGDON VALLEY PA
19006-6423
US

IV. Provider business mailing address

302 WELSH RD
HUNTINGDON VALLEY PA
19006-6423
US

V. Phone/Fax

Practice location:
  • Phone: 973-797-9790
  • Fax:
Mailing address:
  • Phone: 646-404-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0148861
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00342600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA063450
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL56767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: