Provider Demographics
NPI:1619027562
Name:LOPE, PETER L (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:LOPE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 STATE ROUTE 79
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4061
Mailing Address - Country:US
Mailing Address - Phone:732-591-1122
Mailing Address - Fax:732-591-2633
Practice Address - Street 1:479 STATE ROUTE 79
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4061
Practice Address - Country:US
Practice Address - Phone:732-591-1122
Practice Address - Fax:732-591-2633
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT83044Medicare UPIN
NJ036320Medicare ID - Type Unspecified