Provider Demographics
NPI:1750544078
Name:LOPRESTI, NATHALIE SOFIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:NATHALIE
Middle Name:SOFIA
Last Name:LOPRESTI
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:NATHALIE
Other - Middle Name:SOFIA
Other - Last Name:LONDONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:194 HIGHWAY 35 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:718-226-4324
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:194 HIGHWAY 35 SOUTH
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-483-1800
Practice Address - Fax:732-483-1622
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03258931Medicaid
NYA400015567Medicare PIN