Provider Demographics
NPI:1629406723
Name:LOPEZ, EDWARD B (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:B
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 FOX MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2904
Mailing Address - Country:US
Mailing Address - Phone:914-595-7551
Mailing Address - Fax:914-595-7548
Practice Address - Street 1:27 CRANE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4251
Practice Address - Country:US
Practice Address - Phone:914-472-4404
Practice Address - Fax:914-472-7547
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist