Jefferson Gonzalo Lopez, PA
NPI #1407619455 in Central Islip, New York
Provider Information
- NPI Number
- 1407619455
- Entity Type
- Individual
- Name
- Jefferson Gonzalo Lopez, PA
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Physician Assistant
- Credential
- PA
- Enumeration Date
- Feb 2, 2024
- Last Updated
- Feb 2, 2024
Practice Location
- Address
- 225 EASTVIEW DR
- City
- Central Islip
- State
- New York
- ZIP Code
- 11722-4539
- Phone
- (631) 665-1600
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant |
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