1245521202 NPI number — DR. HANA GABRIELLE LOPEZ-QUINONES MD

Table of content: DR. HANA GABRIELLE LOPEZ-QUINONES MD (NPI 1245521202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245521202 NPI number — DR. HANA GABRIELLE LOPEZ-QUINONES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ-QUINONES
Provider First Name:
HANA
Provider Middle Name:
GABRIELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1245521202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 PELHAM PARKWAY SOUTH
Provider Second Line Business Mailing Address:
PLASTIC SURGERY DEPT BLDG 1, 2ND FLOOR, ROOM 209
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-918-5965
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 PELHAM PARKWAY SOUTH
Provider Second Line Business Practice Location Address:
BUILDING 1, ROOM 209
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-918-5965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2011

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: 2086S0102X , with the licence number:  300790 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 300790 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300790 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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