Provider Demographics
NPI:1558337543
Name:LOPEZ, GERARDO DEJESUS (MD FACOG)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:DEJESUS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 ROUTE 37 W
Mailing Address - Street 2:STE 101
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-9998
Mailing Address - Country:US
Mailing Address - Phone:732-244-9444
Mailing Address - Fax:732-244-9468
Practice Address - Street 1:79 ROUTE 37 W
Practice Address - Street 2:STE 101
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-9998
Practice Address - Country:US
Practice Address - Phone:732-244-9444
Practice Address - Fax:732-244-9468
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92336Medicare UPIN