Provider Demographics
NPI:1073639530
Name:DUMITRU, DAN LUCIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:LUCIAN
Last Name:DUMITRU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 JOHN F KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2107
Mailing Address - Country:US
Mailing Address - Phone:201-710-0948
Mailing Address - Fax:
Practice Address - Street 1:1810 JOHN F KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2107
Practice Address - Country:US
Practice Address - Phone:201-710-0948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA091244002084S0012X, 204R00000X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0361542Medicaid
LA1065641Medicaid
LA1065641Medicaid
LA4N263C529Medicare PIN