Provider Demographics
NPI:1245213271
Name:BOBILA, ALEXIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:C
Last Name:BOBILA
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 1:1037 ROUTE 46
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2451
Mailing Address - Country:US
Mailing Address - Phone:973-471-8852
Mailing Address - Fax:
Practice Address - Street 1:1037 ROUTE 46
Practice Address - Street 2:SUITE #103
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2451
Practice Address - Country:US
Practice Address - Phone:973-471-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA032608002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3144101Medicaid
NJ3144101Medicaid
NJ482337Medicare ID - Type Unspecified