Healthcare Provider Details

I. General information

NPI: 1902722705
Provider Name (Legal Business Name): JUAN ANTONIO LOPEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 HALPERIN AVE
BRONX NY
10461-2631
US

IV. Provider business mailing address

3215 CURRY ST
YORKTOWN HEIGHTS NY
10598-2608
US

V. Phone/Fax

Practice location:
  • Phone: 718-681-6565
  • Fax:
Mailing address:
  • Phone: 347-827-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN47157
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: