Provider Demographics
NPI:1972637197
Name:LOPEZ, ROLANDO A (MS PT)
Entity type:Individual
Prefix:
First Name:ROLANDO
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 WINDJAMMER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-2266
Mailing Address - Country:US
Mailing Address - Phone:973-386-9000
Mailing Address - Fax:973-386-1812
Practice Address - Street 1:3 GREENHILL RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4703
Practice Address - Country:US
Practice Address - Phone:973-386-9000
Practice Address - Fax:973-386-1812
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00841900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ041953SO7Medicare UPIN
NJ030581Medicare PIN