MEDICARE: LOR MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	199622	NY

General Provider Information

NPI Number	:	1073533469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOR MEDICAL PC

Provider Business Mailing Address
First Line	:	1810 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3609
Country	:	US
Telephone Number	:	718-616-1000
Fax Number	:	718-616-1110

Provider Business Practice Location Address
First Line	:	1810 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3609
Country	:	US
Telephone Number	:	718-616-1000
Fax Number	:	718-616-1110

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL IGOR BRANOVAN
Credential	:	M.D.
Telephone Number	:	718-616-1000

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	10/25/2012

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Directions to “LOR MEDICAL PC ” Practice Location

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