Healthcare Provider Details

I. General information

NPI: 1609920842
Provider Name (Legal Business Name): ANDREI BOTEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

30 BERGEN ST ADMC 12 1205
NEWARK NJ
07107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5254
  • Fax: 973-972-4172
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number25MA07151000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: