Provider Demographics
NPI:1982628004
Name:LSR ADVANCED MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:LSR ADVANCED MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:REPNINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-368-2200
Mailing Address - Street 1:2965 OCEAN PKWY
Mailing Address - Street 2:1 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8014
Mailing Address - Country:US
Mailing Address - Phone:718-368-2200
Mailing Address - Fax:718-368-0400
Practice Address - Street 1:2965 OCEAN PKWY
Practice Address - Street 2:1 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8014
Practice Address - Country:US
Practice Address - Phone:718-368-2200
Practice Address - Fax:718-368-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWDW092Medicare PIN