Healthcare Provider Details

I. General information

NPI: 1285696849
Provider Name (Legal Business Name): REGINA IMELDA MCINERNEY-LOPEZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BAYSHORE ROAD
NORTH BABYLON NY
11530
US

IV. Provider business mailing address

800 AXINN AVE
GARDEN CITY NY
11530-2139
US

V. Phone/Fax

Practice location:
  • Phone: 631-586-2700
  • Fax: 631-586-3524
Mailing address:
  • Phone: 646-680-2894
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number244077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: