Provider Demographics
NPI:1588686570
Name:LOPEZ, LEONARDO N (DO,FAAP)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:N
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DO,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 STILLWELLS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2969
Mailing Address - Country:US
Mailing Address - Phone:732-780-3333
Mailing Address - Fax:732-780-6968
Practice Address - Street 1:470 STILLWELLS CORNER RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2969
Practice Address - Country:US
Practice Address - Phone:732-780-3333
Practice Address - Fax:732-780-6968
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07161700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8855404Medicaid