Healthcare Provider Details

I. General information

NPI: 1750544078
Provider Name (Legal Business Name): NATHALIE SOFIA LOPRESTI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATHALIE SOFIA LONDONO PA-C

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 04/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 HIGHWAY 35 SOUTH
RED BANK NJ
07701
US

IV. Provider business mailing address

194 HIGHWAY 35 SOUTH
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-483-1800
  • Fax: 732-483-1622
Mailing address:
  • Phone: 718-226-4324
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number013279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: