Provider Demographics
NPI:1992768337
Name:LOPEZ-CANTOR, MARIA TEREZA SAMSON (ANP-BC)
Entity type:Individual
Prefix:
First Name:MARIA TEREZA
Middle Name:SAMSON
Last Name:LOPEZ-CANTOR
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17 EAST 102ND STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-659-8551
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L.LEVY PLACE
Practice Address - Street 2:BOX 3000
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-987-3100
Practice Address - Fax:212-731-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-303793363LA2200X
NYF303793363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1159G1Medicare ID - Type Unspecified
NYQ47282Medicare UPIN