1184223224 NPI number — CHERYL LOPEZ THERAPY

Table of content: (NPI 1184223224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184223224 NPI number — CHERYL LOPEZ THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERYL LOPEZ THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1184223224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
732 KING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10573-2345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-231-0389
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 WESTCHESTER AVE STE N641
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RYE BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10573-1360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-231-0389
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER/SOLE MEMBER
Authorized Official Telephone Number:
914-240-6694

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008097451 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1710322391 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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