Provider Demographics
NPI:1285696849
Name:MCINERNEY-LOPEZ, REGINA IMELDA (DO)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:IMELDA
Last Name:MCINERNEY-LOPEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AXINN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2139
Mailing Address - Country:US
Mailing Address - Phone:646-680-2894
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:300 BAYSHORE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:631-586-2700
Practice Address - Fax:631-586-3524
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244077208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02888842Medicaid
NY02888842Medicaid
NY899923K511Medicare PIN