Provider Demographics
NPI:1871306449
Name:ZACKS, DEENA (IBCLC)
Entity type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:ZACKS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HURLEY CT APT 2
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5255
Mailing Address - Country:US
Mailing Address - Phone:929-703-0066
Mailing Address - Fax:
Practice Address - Street 1:808 HURLEY CT APT 2
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5255
Practice Address - Country:US
Practice Address - Phone:929-703-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-314426174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN