Provider Demographics
NPI:1629273883
Name:MAUGHAN, ELLEN B (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:B
Last Name:MAUGHAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2428
Mailing Address - Country:US
Mailing Address - Phone:732-249-3096
Mailing Address - Fax:732-249-3096
Practice Address - Street 1:240 WAYNE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2428
Practice Address - Country:US
Practice Address - Phone:732-249-3096
Practice Address - Fax:732-249-3096
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN