Provider Demographics
NPI:1124392857
Name:JOSEPH I. LOPEZ, M.D., P.C.
Entity Type:Organization
Organization Name:JOSEPH I. LOPEZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-671-4110
Mailing Address - Street 1:10 MEDICAL PLZ
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2101
Mailing Address - Country:US
Mailing Address - Phone:516-671-4110
Mailing Address - Fax:516-759-4069
Practice Address - Street 1:10 MEDICAL PLZ
Practice Address - Street 2:SUITE 103
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2101
Practice Address - Country:US
Practice Address - Phone:516-671-4110
Practice Address - Fax:516-759-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1464481207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty