Provider Demographics
NPI:1770036766
Name:BERTRANG, EDEN (IBCLC, CCCE, CD)
Entity Type:Individual
Prefix:MS
First Name:EDEN
Middle Name:
Last Name:BERTRANG
Suffix:
Gender:F
Credentials:IBCLC, CCCE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 41ST ST
Mailing Address - Street 2:APT 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-3171
Mailing Address - Country:US
Mailing Address - Phone:917-648-9581
Mailing Address - Fax:
Practice Address - Street 1:661 41ST ST
Practice Address - Street 2:APT 3C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-3171
Practice Address - Country:US
Practice Address - Phone:917-648-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator