Provider Demographics
NPI:1821049289
Name:LOPEZ, DENNIS C (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 HOPEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1335
Mailing Address - Country:US
Mailing Address - Phone:845-896-5380
Mailing Address - Fax:845-896-5161
Practice Address - Street 1:1222 HOPEWELL AVE
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1335
Practice Address - Country:US
Practice Address - Phone:845-896-5380
Practice Address - Fax:845-896-5161
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0106851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10034488OtherCDPHP
812481OtherMPN
1359759OtherUNITEDHEALTHCARE
Q75821OtherBLUE CROSS BLUE SHIELD
000000079904OtherGHI
4409619OtherAETNA
NYQ7582QBII1OtherMEDICARE UNSPECIFIED
327283OtherMVP
7004008OtherCIGNA
1359759OtherUNITEDHEALTHCARE