Individual
LOPA M MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
350 ENGLE ST, ENGLEWOOD, NJ 07631-1808
(201) 894-3000
Mailing address
208 BLOOMFIELD AVE, BLOOMFIELD, NJ 07003-5794
(732) 986-2769
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25MA10622800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA10622800
NJ LICENSE
NJ
Enumeration date
04/15/2014
Last updated
08/20/2019
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