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General NPI Number Information
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NPI Number | 1326708348
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Entity Type | Individual
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Provider Name | JULISSA LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 66 W GILBERT ST
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City | TINTON FALLS
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State | NJ
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Zip | 07701-4947
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Country | US
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Telephone | 732-212-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 50 KINROSS PL
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City | YONKERS
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State | NY
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Zip | 10703-2018
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Country | US
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Telephone | 646-275-6599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 348470
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License Number State | NY
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