Provider Demographics
NPI:1417047648
Name:LOPRESTI, PHILIP JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:LOPRESTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 AUSTIN ST
Mailing Address - Street 2:STE 400
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4245
Mailing Address - Country:US
Mailing Address - Phone:248-855-5355
Mailing Address - Fax:
Practice Address - Street 1:10810 72ND AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5338
Practice Address - Country:US
Practice Address - Phone:718-261-1471
Practice Address - Fax:718-261-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194532208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG79351Medicare UPIN
NY03680AMedicare ID - Type Unspecified