Provider Demographics
NPI:1992187736
Name:VARGAS, MARYELENA (IBCLC, PHD, RN)
Entity Type:Individual
Prefix:DR
First Name:MARYELENA
Middle Name:
Last Name:VARGAS
Suffix:
Gender:F
Credentials:IBCLC, PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 SHEPARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3223
Mailing Address - Country:US
Mailing Address - Phone:201-519-4893
Mailing Address - Fax:
Practice Address - Street 1:272 SHEPARD AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3223
Practice Address - Country:US
Practice Address - Phone:201-519-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09190800163WL0100X
NY533603163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant