Provider Demographics
NPI:1497961361
Name:KOTLEN, MELISSA LORI (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LORI
Last Name:KOTLEN
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 1:175 E 96TH ST APT 18O
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6209
Mailing Address - Country:US
Mailing Address - Phone:914-374-1632
Mailing Address - Fax:
Practice Address - Street 1:175 E 96TH ST APT 18O
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6209
Practice Address - Country:US
Practice Address - Phone:914-374-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY785274-01163WL0100X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant