Provider Demographics
NPI:1114369329
Name:LOPEZ, JOHN D (BA, MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1708
Mailing Address - Country:US
Mailing Address - Phone:718-614-9221
Mailing Address - Fax:
Practice Address - Street 1:974 E 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1708
Practice Address - Country:US
Practice Address - Phone:718-614-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist