Provider Demographics
NPI:1447205471
Name:BRANCATO, LORRAINE J (MD FICS LLC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:J
Last Name:BRANCATO
Suffix:
Gender:F
Credentials:MD FICS LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE WEST RIDGEWOOD AVE
Mailing Address - Street 2:STE204
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2359
Mailing Address - Country:US
Mailing Address - Phone:201-493-0102
Mailing Address - Fax:201-493-1230
Practice Address - Street 1:ONE WEST RIDGEWOOD AVE
Practice Address - Street 2:STE 204
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-493-0102
Practice Address - Fax:201-493-1230
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2017-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04721800207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0217603Medicaid
NJ0217603Medicaid
NJC56892Medicare UPIN