Provider Demographics
NPI:1730147901
Name:LOPEZ-BERNARD, EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:LOPEZ-BERNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W WHITE HORSE PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9450
Mailing Address - Country:US
Mailing Address - Phone:609-748-2800
Mailing Address - Fax:609-748-6721
Practice Address - Street 1:1401 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7022
Practice Address - Country:US
Practice Address - Phone:609-572-8686
Practice Address - Fax:609-572-6033
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07514000208000000X, 208M00000X
NJ25MA07514000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0081175Medicaid
NJ106027OtherNJ CARPENTERS
NJ60017218OtherHORIZON NJ HEALTH
NJ7841681OtherCIGNA
NJK6413OtherHORIZON BCBS
NJ12049728OtherMULTIPLAN
NJ202797565OtherDEVON
NJ221736OtherUS FAMILY HEALTH PLAN
NJP3627184OtherOXFORD
NJ3K4150OtherHEALTH NET
NJ2410743001OtherAMERIHEALTH
NJ2550979OtherUNITEDHEALTH
NJ7871557OtherAETNA
NJ221736OtherUS FAMILY HEALTH PLAN
NJ3K4150OtherHEALTH NET