Provider Demographics
NPI:1730749615
Name:YANOWITZ, LISA (CNM, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:YANOWITZ
Suffix:
Gender:F
Credentials:CNM, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 4TH AVE APT 10O
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5240
Mailing Address - Country:US
Mailing Address - Phone:917-428-5058
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7494
Practice Address - Country:US
Practice Address - Phone:917-428-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633783-1163WL0100X, 163WP1700X, 163WX0003X
NY002229367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient