Lopez, Michael

Lopez, Michael is an sole proprietor health care provider with primary practice located at 403 Lake Dr , Medford NY 11763-4606. He recently has 2 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Dietitian, Registered, Dietary & Nutritional Service Providers / Nutritionist. Dietary & Nutritional Service Providers / Nutritionist is his primary health care specialty. Lopez, Michael can be contacted via phone (718) 578-1375.

Contact Information

Primary practice address
403 Lake Dr Medford NY 11763-4606
Phone: (718) 578-1375
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X New York
Dietary & Nutritional Service Providers / Nutritionist 133N00000X New York

Profile Details

NPI number 1255815593
LBN Legal business name Lopez, Michael
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 22nd, 2018
Last updated Sep 22nd, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255815593 NPPES
New York MEDICAID 0000567890

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