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General NPI Number Information
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NPI Number | 1609947878
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Entity Type | Individual
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Provider Name | JOSEPH I LOPEZ MD
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 86 FOREST AVE STE 1-C
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City | GLEN COVE
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State | NY
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Zip | 11542-2194
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Country | US
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Telephone | 516-671-4110
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Fax | 517-759-4069
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Provider Business Mailing Address
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Address Line | 86 FOREST AVE STE 1-C
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City | GLEN COVE
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State | NY
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Zip | 11542-2194
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Country | US
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Telephone | 516-671-4110
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Fax | 517-759-4069
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 146448
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License Number State | NY
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