Provider Demographics
NPI:1518691070
Name:MATLOSZ, EMILY DEMURO (IBCLC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DEMURO
Last Name:MATLOSZ
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:DEMURO
Other - Last Name:MATLOSZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:145 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2138
Mailing Address - Country:US
Mailing Address - Phone:973-641-4145
Mailing Address - Fax:
Practice Address - Street 1:109 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2322
Practice Address - Country:US
Practice Address - Phone:973-641-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJL-307341174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN