Provider Demographics
NPI:1013099449
Name:LOPEZ, BARBARA JEAN (PA)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JEAN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CRIMSON LN
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-2444
Mailing Address - Country:US
Mailing Address - Phone:973-343-7204
Mailing Address - Fax:
Practice Address - Street 1:110 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6013
Practice Address - Country:US
Practice Address - Phone:973-349-7397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP 00046600363AM0700X
NY005259363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical