Individual provider Active NPI

Christina Nereida Lopez, EDM

  • Specialist
  • Bay Shore, NY
National Provider Identifier
1063967198
Registry record updated Aug 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
1039786161 Issued in NY
Practice address
107 Rhode Island Ave
Bay Shore, NY 11706-3210
Phone
(631) 219-5863
NPI assigned
Aug 18, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 1039786161 NY Primary
Specialist 174400000X 1039791161 NY

Addresses

Primary practice location

107 Rhode Island Ave
Bay Shore, NY 11706-3210

Mailing address

107 Rhode Island Ave
Bay Shore, NY 11706-3210
Phone (631) 219-5863

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1039786161NYMDSpecialist
1039791161NYMDSpecialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471478400000",
    "number": "1063967198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 RHODE ISLAND AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117063210",
            "telephone_number": "631-219-5863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 RHODE ISLAND AVE",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117063210",
            "telephone_number": "631-219-5863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "CHRISTINA",
        "middle_name": "NEREIDA",
        "credential": "EDM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-18",
        "last_updated": "2016-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1039786161",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "1039791161",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.