Provider Demographics
NPI:1629021399
Name:LOPEZ, DAVID V (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WHITE RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1150
Mailing Address - Country:US
Mailing Address - Phone:732-888-2100
Mailing Address - Fax:732-888-2188
Practice Address - Street 1:200 WHITE RD STE 1C
Practice Address - Street 2:ORTHOPAEDICS & SPORTS MEDICINE SPECIALISTS,INC
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1150
Practice Address - Country:US
Practice Address - Phone:732-888-2100
Practice Address - Fax:732-888-2188
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07887100207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0082295Medicaid
NJ091941Medicare ID - Type UnspecifiedMEDICARE ID#
NJI10942Medicare UPIN