Provider Demographics
NPI:1861505950
Name:DENNIS C. LOPEZ PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:DENNIS C. LOPEZ PHYSICAL THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-896-5380
Mailing Address - Street 1:1222 HOPEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1335
Mailing Address - Country:US
Mailing Address - Phone:845-896-5380
Mailing Address - Fax:845-896-5161
Practice Address - Street 1:1222 HOPEWELL AVE
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1335
Practice Address - Country:US
Practice Address - Phone:845-896-5380
Practice Address - Fax:845-896-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYANC 1753OtherOXFORD FACILITY ID#
NY0013801OtherFACILITY ID#ORTHNET AETNA
NY=========OtherMAGNACARE
NY0013801OtherFACILITY ID#ORTHNET AETNA
NY=========OtherPOMCO
NYQBWII1Medicare PIN