Individual
INGRID LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3000
Mailing address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
NY
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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