Provider Demographics
NPI:1962618827
Name:KAZNELSON, AYELET (IBCLC, CLC)
Entity type:Individual
Prefix:MS
First Name:AYELET
Middle Name:
Last Name:KAZNELSON
Suffix:
Gender:F
Credentials:IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 W 72ND ST
Mailing Address - Street 2:APT B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2807
Mailing Address - Country:US
Mailing Address - Phone:917-620-4068
Mailing Address - Fax:
Practice Address - Street 1:244 W 72ND ST
Practice Address - Street 2:APT B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2807
Practice Address - Country:US
Practice Address - Phone:917-620-4068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10420788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
562468761OtherTAX ID NUMBER