Provider Demographics
NPI:1184279911
Name:LOPEZ, JEMARY DOLORES
Entity type:Individual
Prefix:
First Name:JEMARY
Middle Name:DOLORES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVERDALE AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4903
Mailing Address - Country:US
Mailing Address - Phone:929-447-5262
Mailing Address - Fax:929-447-5260
Practice Address - Street 1:1 RIVERDALE AVE STE 10
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4903
Practice Address - Country:US
Practice Address - Phone:929-447-5262
Practice Address - Fax:929-447-5260
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator