Provider Demographics
NPI:1073533469
Name:LOR MEDICAL PC
Entity Type:Organization
Organization Name:LOR MEDICAL PC
Other - Org Name:DANIEL BRANOVAN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:IGOR
Authorized Official - Last Name:BRANOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-616-1000
Mailing Address - Street 1:1810 VOORHIES AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3609
Mailing Address - Country:US
Mailing Address - Phone:718-616-1000
Mailing Address - Fax:718-616-1110
Practice Address - Street 1:1810 VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3609
Practice Address - Country:US
Practice Address - Phone:718-616-1000
Practice Address - Fax:718-616-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG67829Medicare UPIN