Provider Demographics
NPI:1780917906
Name:MOTHERS' MILK BANK NORTHEAST, INC.
Entity type:Organization
Organization Name:MOTHERS' MILK BANK NORTHEAST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAR-YAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-527-6263
Mailing Address - Street 1:377 ELLIOT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1126
Mailing Address - Country:US
Mailing Address - Phone:617-527-6263
Mailing Address - Fax:
Practice Address - Street 1:377 ELLIOT ST
Practice Address - Street 2:
Practice Address - City:NEWTON UPPER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02464-1126
Practice Address - Country:US
Practice Address - Phone:617-527-6263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty