Healthcare Provider Details

I. General information

NPI: 1093383101
Provider Name (Legal Business Name): NICOLE J LOPRINZI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S MAPLE AVE
RIDGEWOOD NJ
07450-4561
US

IV. Provider business mailing address

85 S MAPLE AVE
RIDGEWOOD NJ
07450-4561
US

V. Phone/Fax

Practice location:
  • Phone: 201-445-2830
  • Fax: 201-445-7471
Mailing address:
  • Phone: 201-445-2830
  • Fax: 201-445-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00629600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: