Provider Demographics
NPI:1083487672
Name:AYANRU, AMENAGHAWON (IBCLC)
Entity Type:Individual
Prefix:
First Name:AMENAGHAWON
Middle Name:
Last Name:AYANRU
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEADOW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2001
Mailing Address - Country:US
Mailing Address - Phone:718-749-4681
Mailing Address - Fax:
Practice Address - Street 1:280 S HARRISON ST STE 311
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1960
Practice Address - Country:US
Practice Address - Phone:862-298-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-132309174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN