Provider Demographics
NPI:1578288957
Name:LOPEZ, URIS MADELYNE
Entity Type:Individual
Prefix:
First Name:URIS
Middle Name:MADELYNE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 52ND ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4542
Mailing Address - Country:US
Mailing Address - Phone:718-458-4243
Mailing Address - Fax:
Practice Address - Street 1:43-08 52ND STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4542
Practice Address - Country:US
Practice Address - Phone:718-458-4243
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program