Provider Demographics
NPI:1730646340
Name:EMPIRE LACTATION, INC.
Entity Type:Organization
Organization Name:EMPIRE LACTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, IBCLC
Authorized Official - Phone:718-450-2694
Mailing Address - Street 1:29 ROUSNER LN
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4512
Mailing Address - Country:US
Mailing Address - Phone:718-450-2694
Mailing Address - Fax:
Practice Address - Street 1:29 ROUSNER LN
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-4512
Practice Address - Country:US
Practice Address - Phone:718-450-2694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1043566763Medicaid