Individual provider Active NPI

Lisa Lopez

  • Physician Assistant
  • New York, NY
National Provider Identifier
1760025134
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
026454 Issued in NY
Practice address
160 Convent Ave
The Cuny School of Medicine- PA Program Office
New York, NY 10031
Phone
(212) 650-7812
NPI assigned
Oct 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 026454 NY Primary

Addresses

Primary practice location

160 Convent Ave
The Cuny School of Medicine- PA Program Office
New York, NY 10031

Mailing address

4205 Layton St Apt 4F
Elmhurst, NY 11373-2305
Phone (917) 651-7097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210504001378 NY Practitioner - Physician Assistant 6507275526 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
City University of New York School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-0580

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-5220

PO Box
Suite 1554
Stony Brook, NY 11790-0989

Hospital & facility affiliations

  • Mount Sinai West Hospital, New York, NY, CCN 330046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
026454NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 1, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Sep 1, 2023 Accepting new patients
Fpa Hospital Based CurrentSince Apr 14, 2021 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

3201 Kings Hwy
Brooklyn, NY 11234
Phone (718) 252-3000

300 Cadman Plz W
Fl 18
Brooklyn, NY 11201
Phone (929) 210-6000

2510 30th Ave
Long Island City, NY 11102
Phone (718) 267-4245

638 Columbus Ave
New York, NY 10024
Phone (212) 523-8672

234 E 85th St
New York, NY 10028
Phone (212) 241-6585

1468 Madison Ave
#3220
New York, NY 10029

5 E 98th St
New York, NY 10029
Phone (212) 241-3986

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

1440 Madison Ave
New York, NY 10029
Phone (212) 241-5561

1111 Amsterdam Ave
New York, NY 10025
Phone (212) 523-2309

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1760025134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 LAYTON ST APT 4F",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113732305",
            "telephone_number": "917-651-7097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 CONVENT AVE",
            "address_2": "THE CUNY SCHOOL OF MEDICINE- PA PROGRAM OFFICE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10031",
            "telephone_number": "212-650-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "LISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-17",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.