MEDICARE: INNA BOSTANCI LMT, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)
2	225700000X	Massage Therapist	027527	NY

General Provider Information

NPI Number	:	1417422833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA BOSTANCI LMT, IBCLC

Provider Business Mailing Address
First Line	:	1036 PARK AVE # 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0971
Country	:	US
Telephone Number	:	212-303-7680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 PARK AVE # 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10028-0971
Country	:	US
Telephone Number	:	917-903-2307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	02/02/2023

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