=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598093940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY LOU MORAMARCO IBCLC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2009
-----------------------------------------------------
Last Update Date | 11/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 LINE RD
-----------------------------------------------------
City | HOLMDEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07733-1684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-239-7771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 LINE RD
-----------------------------------------------------
City | HOLMDEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07733-1684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-239-7771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------