Provider Demographics
NPI:1225407497
Name:PERNIKOFF, ESTHER RIVKA (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:RIVKA
Last Name:PERNIKOFF
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4707
Mailing Address - Country:US
Mailing Address - Phone:848-299-2322
Mailing Address - Fax:
Practice Address - Street 1:14 HENRY ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4707
Practice Address - Country:US
Practice Address - Phone:848-299-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJL-68373163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant