Provider Demographics
NPI:1487197687
Name:YUMMY MUMMY, LLC
Entity Type:Organization
Organization Name:YUMMY MUMMY, LLC
Other - Org Name:LATCHON BY YUMMY MUMMY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-879-8669
Mailing Address - Street 1:600 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3453
Mailing Address - Country:US
Mailing Address - Phone:516-931-6300
Mailing Address - Fax:516-931-6348
Practice Address - Street 1:1201 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1437
Practice Address - Country:US
Practice Address - Phone:855-879-8669
Practice Address - Fax:855-291-5930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YUMMY MUMMY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03707215Medicaid
VT1023867Medicaid
OH0089273Medicaid
OH0089273Medicaid