Provider Demographics
NPI:1477934685
Name:LOPEZ, ANNE BRIDGET (RD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:BRIDGET
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 1ST AVE APT 7F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4631
Mailing Address - Country:US
Mailing Address - Phone:917-204-5897
Mailing Address - Fax:
Practice Address - Street 1:41 OLD CASTLE POINT ROAD
Practice Address - Street 2:
Practice Address - City:WAPPINGER FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY859184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered