Healthcare Provider Details

I. General information

NPI: 1255247607
Provider Name (Legal Business Name): AMY ALEXANDRA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COURT ST STE 1217
BROOKLYN NY
11201-4410
US

IV. Provider business mailing address

22433 FAIRBURY AVE
QUEENS VILLAGE NY
11428-1927
US

V. Phone/Fax

Practice location:
  • Phone: 347-970-2188
  • Fax:
Mailing address:
  • Phone: 929-232-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number028691-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: