Provider Demographics
NPI:1013918325
Name:RAMIREZ, EPIFANIA LOPEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:EPIFANIA
Middle Name:LOPEZ
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-2501
Mailing Address - Country:US
Mailing Address - Phone:973-824-8226
Mailing Address - Fax:973-824-0193
Practice Address - Street 1:1119 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2501
Practice Address - Country:US
Practice Address - Phone:973-824-8226
Practice Address - Fax:973-824-0193
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA034294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1972804Medicaid
NJ1972804Medicaid
NJ455533Medicare ID - Type Unspecified