Healthcare Provider Details

I. General information

NPI: 1083252365
Provider Name (Legal Business Name): LANA VORONIN PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 SHEEPSHEAD BAY RD
BROOKLYN NY
11224-3602
US

IV. Provider business mailing address

626 SHEEPSHEAD BAY RD
BROOKLYN NY
11224-3602
US

V. Phone/Fax

Practice location:
  • Phone: 347-612-7441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LANA VORONIN
Title or Position: OWNER
Credential: MD
Phone: 347-612-7441