Healthcare Provider Details

I. General information

NPI: 1710818679
Provider Name (Legal Business Name): FRANKIE RAUL LOPEZ MS,LAT,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BROAD ST STE 250
BLOOMFIELD NJ
07003-3066
US

IV. Provider business mailing address

2401 BERGENLINE AVE APT 6D
UNION CITY NJ
07087-3670
US

V. Phone/Fax

Practice location:
  • Phone: 201-431-0534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: