=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265760888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACKLYN LAHAV CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2009
-----------------------------------------------------
Last Update Date | 12/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1718 E 22ND ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-750-0388
-----------------------------------------------------
Fax | 888-815-3905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1718 E 22ND ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11229-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-750-0388
-----------------------------------------------------
Fax | 888-815-3905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | F001358
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------