Provider Demographics
NPI:1609947878
Name:LOPEZ, JOSEPH I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:I
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:86 FOREST AVE STE 1-C
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2194
Mailing Address - Country:US
Mailing Address - Phone:516-671-4110
Mailing Address - Fax:517-759-4069
Practice Address - Street 1:86 FOREST AVE STE 1-C
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2194
Practice Address - Country:US
Practice Address - Phone:516-671-4110
Practice Address - Fax:517-759-4069
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY146448204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23E511Medicare ID - Type Unspecified