MEDICARE: BRANAC NY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	038236	OTHER	PHARMACY LICENSE
3	2062608	OTHER	PK

General Provider Information

NPI Number	:	1568569499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANAC NY LLC

Provider Business Mailing Address
First Line	:	1047 SURF AVE
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2810
Country	:	US
Telephone Number	:	212-249-8202
Fax Number	:	917-722-0851

Provider Business Practice Location Address
First Line	:	2720 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2006
Country	:	US
Telephone Number	:	718-333-2525
Fax Number	:	718-333-0955

Authorized Official
Title or Position	:	PIC
Name	:	ERICA MOISEYEV
Credential	:
Telephone Number	:	718-333-2525

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/04/2023

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