Provider Demographics
NPI:1982999140
Name:LOPEZ, NICOLE MM (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MM
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NEWARK AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1193
Mailing Address - Country:US
Mailing Address - Phone:973-969-1020
Mailing Address - Fax:973-751-2890
Practice Address - Street 1:50 NEWARK AVE STE 307
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1193
Practice Address - Country:US
Practice Address - Phone:973-969-1020
Practice Address - Fax:973-751-2890
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10178800207X00000X, 207XS0106X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program