MEDICARE: MR. SEMYON LORBERG RPH

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	183500000X	Pharmacist	041961	NY

General Provider Information

NPI Number	:	1114106101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEMYON LORBERG RPH

Provider Business Mailing Address
First Line	:	29 BARTMAN RD
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-4635
Country	:	US
Telephone Number	:	718-843-4477
Fax Number	:

Provider Business Practice Location Address
First Line	:	10919 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1703
Country	:	US
Telephone Number	:	718-843-4477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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