Provider Demographics
NPI:1679142137
Name:PISANO, ARACELIS (IBCLC)
Entity Type:Individual
Prefix:
First Name:ARACELIS
Middle Name:
Last Name:PISANO
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 1:1316 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4222
Mailing Address - Country:US
Mailing Address - Phone:917-828-6496
Mailing Address - Fax:
Practice Address - Street 1:1316 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4222
Practice Address - Country:US
Practice Address - Phone:917-828-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-20
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-161573174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN