Provider Demographics
NPI:1659967511
Name:LOPEZ, NATASHA S (APN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:S
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 VALLEY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2709
Mailing Address - Country:US
Mailing Address - Phone:973-432-3398
Mailing Address - Fax:973-561-3091
Practice Address - Street 1:28 VALLEY RD STE 1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2709
Practice Address - Country:US
Practice Address - Phone:973-981-0441
Practice Address - Fax:973-561-3091
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01086700363LA2200X, 363LG0600X, 363LP0808X
NY406998363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology