MEDICARE: LSR ADVANCED MEDICAL CARE PLLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1982628004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSR ADVANCED MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	2965 OCEAN PKWY
Second Line	:	1 FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8014
Country	:	US
Telephone Number	:	718-368-2200
Fax Number	:	718-368-0400

Provider Business Practice Location Address
First Line	:	2965 OCEAN PKWY
Second Line	:	1 FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8014
Country	:	US
Telephone Number	:	718-368-2200
Fax Number	:	718-368-0400

Authorized Official
Title or Position	:	MANAGER
Name	:	LARISA REPNINA
Credential	:
Telephone Number	:	718-368-2200

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/11/2007

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