Individual
JUAN S LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
64 NAGLE AVE FL 2, NEW YORK, NY 10040-1406
(646) 344-1715
(917) 997-9555
Mailing address
19 SAGEMAN STREET, MOUNT VERNON, NY 10550
(914) 699-0989
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
A109431-1
NY
Other
Enumeration date
11/02/2006
Last updated
03/06/2020
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