Provider Demographics
NPI:1245440189
Name:BLANE, CAROLE KIVETT (BA, IBCLC)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:KIVETT
Last Name:BLANE
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OWATONNA ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1812
Mailing Address - Country:US
Mailing Address - Phone:917-407-1166
Mailing Address - Fax:
Practice Address - Street 1:54 RIVERSIDE DR
Practice Address - Street 2:GRA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6509
Practice Address - Country:US
Practice Address - Phone:917-407-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist