Provider Demographics
NPI:1952190811
Name:IMBALZANO, MEGHAN (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:IMBALZANO
Suffix:
Gender:
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ROUTE 46 STE 230E
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2352
Mailing Address - Country:US
Mailing Address - Phone:973-952-6455
Mailing Address - Fax:
Practice Address - Street 1:120 WELLINGTON DR
Practice Address - Street 2:
Practice Address - City:ROARING BROOK TWP
Practice Address - State:PA
Practice Address - Zip Code:18444-9552
Practice Address - Country:US
Practice Address - Phone:570-479-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJL-312658174N00000X
PARN783380163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN