Provider Demographics
NPI:1437105731
Name:LOPEZ, HARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 AUTUMN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3204
Mailing Address - Country:US
Mailing Address - Phone:718-827-0770
Mailing Address - Fax:718-925-2196
Practice Address - Street 1:8716 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2107
Practice Address - Country:US
Practice Address - Phone:718-925-2195
Practice Address - Fax:718-925-2196
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006092213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02639958Medicaid
NYV04408Medicare UPIN
NY07585Medicare PIN