MEDICARE: MEGHAN IMBALZANO BSN, RN, 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)	L-312658	NJ
2	163WL0100X	Lactation Consultant (Registered Nurse)	RN783380	PA

General Provider Information

NPI Number	:	1952190811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHAN IMBALZANO BSN, RN, IBCLC

Provider Business Mailing Address
First Line	:	322 ROUTE 46 STE 230E
Second Line	:
City	:	PARSIPPANY
State	:	NJ
Zip	:	07054-2352
Country	:	US
Telephone Number	:	973-952-6455
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 WELLINGTON DR
Second Line	:
City	:	ROARING BROOK TWP
State	:	PA
Zip	:	18444-9552
Country	:	US
Telephone Number	:	570-479-4158
Fax Number	:

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

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/08/2025

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