MEDICARE: LORRAINE J BRANCATO MD FICS LLC

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	207W00000X	Ophthalmology Physician	25MA04721800	NJ
2	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	25MA04721800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447205471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE J BRANCATO MD FICS LLC

Provider Business Mailing Address
First Line	:	ONE WEST RIDGEWOOD AVE
Second Line	:	STE204
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2359
Country	:	US
Telephone Number	:	201-493-0102
Fax Number	:	201-493-1230

Provider Business Practice Location Address
First Line	:	ONE WEST RIDGEWOOD AVE
Second Line	:	STE 204
City	:	PARAMUS
State	:	NJ
Zip	:	07652-2359
Country	:	US
Telephone Number	:	201-493-0102
Fax Number	:	201-493-1230

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/09/2017

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