Provider Demographics
NPI:1033484977
Name:BARAK, DIKLA Z (BOT, IBCLC)
Entity Type:Individual
Prefix:
First Name:DIKLA
Middle Name:Z
Last Name:BARAK
Suffix:
Gender:F
Credentials:BOT, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 DEAN ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2155
Mailing Address - Country:US
Mailing Address - Phone:646-243-9366
Mailing Address - Fax:
Practice Address - Street 1:507 DEAN ST APT 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2155
Practice Address - Country:US
Practice Address - Phone:646-243-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-10
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11167483174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN