Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jefferson Gonzalo Lopez, PA

Individual provider Physician Assistant · NPI 1407619455

Jefferson Gonzalo Lopez, PA is a Physician Assistant in Central Islip, New York. Practices as a sole proprietor. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

225 Eastview Dr
Central Islip, NY 11722-4539
Phone: (631) 665-1600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1407619455
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedFebruary 2, 2024
Last updated in NPPESFebruary 2, 2024
Certification dateFebruary 2, 2024

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