1104491315 NPI number — DAVID ALEJANDRO LOPEZ MOLINA M.PHIL

Table of content: DAVID ALEJANDRO LOPEZ MOLINA M.PHIL (NPI 1104491315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104491315 NPI number — DAVID ALEJANDRO LOPEZ MOLINA M.PHIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ MOLINA
Provider First Name:
DAVID
Provider Middle Name:
ALEJANDRO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.PHIL
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104491315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PARK AVE FL 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-754-5000
Provider Business Mailing Address Fax Number:
646-754-9538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE PARK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-754-5000
Provider Business Practice Location Address Fax Number:
646-754-9538
Provider Enumeration Date:
05/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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