=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114407210
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPHINE LOPEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2018
-----------------------------------------------------
Last Update Date | 11/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 485 BLOOMFIELD AVE
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07006-5450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-931-9398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 375
-----------------------------------------------------
City | CALDWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07006-7509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-931-9398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 407738
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00837300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------