Provider Demographics
NPI:1083684401
Name:POPA, VINCENTIU (MD)
Entity Type:Individual
Prefix:
First Name:VINCENTIU
Middle Name:
Last Name:POPA
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 1:719 BUTTERNUT DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2281
Mailing Address - Country:US
Mailing Address - Phone:201-925-0277
Mailing Address - Fax:888-766-8193
Practice Address - Street 1:719 BUTTERNUT DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2281
Practice Address - Country:US
Practice Address - Phone:201-925-0277
Practice Address - Fax:888-766-8193
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228490207L00000X
NJ25MA08106100207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02442895Medicaid
I00260Medicare UPIN
NJ104887Medicare PIN
NY8L7731Medicare ID - Type Unspecified