Provider Demographics
NPI:1891180964
Name:LOPEZ RODRIGUEZ, JEAN (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:LOPEZ RODRIGUEZ
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 1:170 MAPLE AVE STE G-1
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4767
Mailing Address - Country:US
Mailing Address - Phone:914-683-0443
Mailing Address - Fax:914-380-1330
Practice Address - Street 1:170 MAPLE AVE STE 309
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4714
Practice Address - Country:US
Practice Address - Phone:914-220-0283
Practice Address - Fax:914-380-1330
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3008502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology