Provider Demographics
NPI:1225329113
Name:LOPEZ, ALFRED MICHAEL (CMT, CHC)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:MICHAEL
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CMT, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-3031
Mailing Address - Country:US
Mailing Address - Phone:856-910-8472
Mailing Address - Fax:888-910-8472
Practice Address - Street 1:1935 46TH ST
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-3031
Practice Address - Country:US
Practice Address - Phone:856-910-8472
Practice Address - Fax:888-910-8472
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133NN1002X
NJ171M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator