Provider Demographics
NPI:1861593881
Name:LOPEZ, LINA M (MD)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74 PASCACK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1935
Mailing Address - Country:US
Mailing Address - Phone:201-930-0900
Mailing Address - Fax:201-391-7733
Practice Address - Street 1:74 PASCACK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1935
Practice Address - Country:US
Practice Address - Phone:201-930-0900
Practice Address - Fax:201-391-7733
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA083345002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J2724Medicare ID - Type Unspecified