Provider Demographics
NPI:1417422833
Name:BOSTANCI, INNA (LMT, IBCLC)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:BOSTANCI
Suffix:
Gender:F
Credentials:LMT, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 PARK AVE # 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0971
Mailing Address - Country:US
Mailing Address - Phone:212-303-7680
Mailing Address - Fax:
Practice Address - Street 1:1036 PARK AVE # 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0971
Practice Address - Country:US
Practice Address - Phone:917-903-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
NY027527225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist