Healthcare Provider Details

I. General information

NPI: 1659297513
Provider Name (Legal Business Name): MISS EVELYN MORALES-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

1 SOUTH AVE
GARDEN CITY NY
11530-4299
US

IV. Provider business mailing address

14966 21ST AVE
WHITESTONE NY
11357-3606
US

V. Phone/Fax

Practice location:
  • Phone: 516-877-4339
  • Fax:
Mailing address:
  • Phone: 646-703-5061
  • Fax:

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: