Provider Demographics
NPI:1609042159
Name:LOPEZ, ANTHONY (PA)
Entity Type:Individual
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First Name:ANTHONY
Middle Name:
Last Name:LOPEZ
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Gender:M
Credentials:PA
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Mailing Address - Street 1:585 SCHENECTADY AVE
Mailing Address - Street 2:MANAGE CARE DEPARTMENT BLUMBERG BUILDING 6TH FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1809
Mailing Address - Country:US
Mailing Address - Phone:718-604-5239
Mailing Address - Fax:718-604-5527
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:MANAGE CARE DEPARTMENT BLUMBERG BUILDING 6TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1809
Practice Address - Country:US
Practice Address - Phone:718-604-5239
Practice Address - Fax:718-604-5527
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
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Provider Licenses
StateLicense IDTaxonomies
NY012477363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical