MEDICARE: DR. MANUEL LOPEZ M.D.

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	207RC0000X	Cardiovascular Disease Physician	213205	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629176300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL LOPEZ M.D.

Provider Business Mailing Address
First Line	:	11 IRENE LN N
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-1913
Country	:	US
Telephone Number	:	718-217-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	9033 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1352
Country	:	US
Telephone Number	:	718-464-5225
Fax Number	:	718-740-8838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	04/26/2018

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