1154367886 NPI number — DR. LENORE J BRANCATO MD

Table of content: DR. LENORE J BRANCATO MD (NPI 1154367886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154367886 NPI number — DR. LENORE J BRANCATO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANCATO
Provider First Name:
LENORE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154367886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1044 NORTHERN BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
ROSLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11576-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-484-6880
Provider Business Mailing Address Fax Number:
516-484-6882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ROSLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11576-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-484-6880
Provider Business Practice Location Address Fax Number:
516-484-6882
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  167757 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113662047 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1090151 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113662047 . This is a "EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 167757 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 346AG1 . This is a "EMPIRE BC BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113662047 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01839445 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1799286 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 225818P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C3722 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1141896 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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