Provider Demographics
NPI:1255950499
Name:LOPEZ, EDWARD ANDRES (RN)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ANDRES
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6154 70TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1212
Mailing Address - Country:US
Mailing Address - Phone:646-251-2958
Mailing Address - Fax:
Practice Address - Street 1:14015 SANFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2688
Practice Address - Country:US
Practice Address - Phone:718-358-5265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY613945163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health