Provider Demographics
NPI:1164623492
Name:CORNEL DUMITRIU MD
Entity Type:Organization
Organization Name:CORNEL DUMITRIU MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMITRIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-728-5529
Mailing Address - Street 1:4525 HENRY HUDSON PKWY
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3808
Mailing Address - Country:US
Mailing Address - Phone:718-728-5529
Mailing Address - Fax:
Practice Address - Street 1:4525 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 1004
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3808
Practice Address - Country:US
Practice Address - Phone:718-728-5529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00225549Medicaid
NYA97203Medicare UPIN
NY00225549Medicaid