MEDICARE: LAN MEDICAL SUPPLY INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1245511724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAN MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	6311 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5508
Country	:	US
Telephone Number	:	917-589-2374
Fax Number	:

Provider Business Practice Location Address
First Line	:	6311 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5508
Country	:	US
Telephone Number	:	917-589-2374
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEONID LASHIKER
Credential	:	C-PED
Telephone Number	:	917-589-2374

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	08/29/2011

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