Provider Demographics
NPI:1184683146
Name:PETCU, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:PETCU
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 1:1 DAG HAMMARSKJOLD BLVD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5221
Mailing Address - Country:US
Mailing Address - Phone:732-761-1788
Mailing Address - Fax:732-761-1323
Practice Address - Street 1:1 DAG HAMMARSKJOLD BLVD
Practice Address - Street 2:SUITE # 3
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5221
Practice Address - Country:US
Practice Address - Phone:732-761-1788
Practice Address - Fax:732-761-1323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7661401Medicaid
NJ021291Medicare ID - Type Unspecified
NJ7661401Medicaid