Provider Demographics
NPI:1497821250
Name:LOPEZ, JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NEWCASTLE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1450
Mailing Address - Country:US
Mailing Address - Phone:973-299-1961
Mailing Address - Fax:
Practice Address - Street 1:17 NEWCASTLE CT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1450
Practice Address - Country:US
Practice Address - Phone:973-625-4106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA36433207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1704702Medicaid
NJ1704702Medicaid
NJ456521Medicare ID - Type Unspecified