Healthcare Provider Details

I. General information

NPI: 1073639530
Provider Name (Legal Business Name): DAN LUCIAN DUMITRU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2107
US

IV. Provider business mailing address

1810 JOHN F KENNEDY BLVD
JERSEY CITY NJ
07305-2107
US

V. Phone/Fax

Practice location:
  • Phone: 201-710-0948
  • Fax:
Mailing address:
  • Phone: 201-710-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number25MA09124400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number25MA09124400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA09124400
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MA09124400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: