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General NPI Number Information
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NPI Number | 1962221481
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Entity Type | Individual
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Provider Name | MADILIZ LOPEZ FNP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 19 SOUTHDOWN RD # 2538
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City | HUNTINGTON
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State | NY
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Zip | 11743-2538
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Country | US
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Telephone | 631-470-2572
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Fax |
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Provider Business Mailing Address
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Address Line | 11909 METROPOLITAN AVE
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City | KEW GARDENS
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State | NY
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Zip | 11415-2605
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Country | US
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Telephone | 347-850-4588
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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 | F355161-01
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License Number State | NY
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