Individual
JEFFREY LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4277 65TH PL, WOODSIDE, NY 11377-5054
(516) 755-7878
Mailing address
4220 67TH ST, WOODSIDE, NY 11377-5059
(347) 990-8685
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/05/2020
Last updated
05/05/2020
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