Provider Demographics
NPI:1265760888
Name:LAHAV, JACKLYN (CNM)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:LAHAV
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1517
Mailing Address - Country:US
Mailing Address - Phone:917-750-0388
Mailing Address - Fax:888-815-3905
Practice Address - Street 1:1718 E 22ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1517
Practice Address - Country:US
Practice Address - Phone:917-750-0388
Practice Address - Fax:888-815-3905
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001358176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife