Individual
BRANDON GAMANIEL LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
776 SHREWSBURY AVE STE 105, TINTON FALLS, NJ 07724-3006
(732) 530-4949
Mailing address
776 SHREWSBURY AVE STE 105, TINTON FALLS, NJ 07724-3006
(732) 530-4949
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00952000
NJ
363AS0400X
Surgical Physician Assistant
25MP00952000
NJ
Other
Enumeration date
08/04/2025
Last updated
09/01/2025
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