Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 146448 | NY |
NPI | 1609947878 |
---|---|
Provider Name | Dr. Joseph I Lopez |
First Address | Glen Cove, NY 11542-2101 |
Second Address | Glen Cove, NY 11542-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 08/07/2007 |