Provider Demographics
NPI:1376817742
Name:SPIVAK, YEKATERINA (RPA-C, IBCLC)
Entity Type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:
Last Name:SPIVAK
Suffix:
Gender:F
Credentials:RPA-C, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6423
Mailing Address - Country:US
Mailing Address - Phone:646-404-6591
Mailing Address - Fax:
Practice Address - Street 1:302 WELSH RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6423
Practice Address - Country:US
Practice Address - Phone:973-797-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL56767174N00000X
NY0148861363A00000X
NJ25MP00342600363A00000X
PAMA063450363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical