Healthcare Provider Details

I. General information

NPI: 1417047648
Provider Name (Legal Business Name): PHILIP JOHN LOPRESTI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 57TH ST RM 202
NEW YORK NY
10022-2645
US

IV. Provider business mailing address

6860 AUSTIN ST STE 400
FOREST HILLS NY
11375-4245
US

V. Phone/Fax

Practice location:
  • Phone: 866-607-2308
  • Fax:
Mailing address:
  • Phone: 248-855-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB06674000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number194532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: