Healthcare Provider Details

I. General information

NPI: 1225604143
Provider Name (Legal Business Name): VERONICA ROCIO JACOME LOPEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF MEDICINE 350 ENGLE STREET
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

DEPARTMENT OF MEDICINE 350 ENGLE STREET
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3495
  • Fax: 201-894-0839
Mailing address:
  • Phone: 201-894-3495
  • Fax: 201-894-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: