Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 25MA09317900 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | 276754 | NY |
NPI | 1134431554 |
---|---|
Provider Name | Dr. Joseph Weber-Lopez |
First Address | Huntington, NY 11743-2988 |
Second Address | Huntington, NY 11743-2988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2010 |
Last Update Date | 27/03/2019 |