Provider Demographics
NPI:1548306608
Name:BANCILA, ALEXANDRU (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRU
Middle Name:
Last Name:BANCILA
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 1:250 S ADELAIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1654
Mailing Address - Country:US
Mailing Address - Phone:732-545-8677
Mailing Address - Fax:
Practice Address - Street 1:250 S ADELAIDE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-1654
Practice Address - Country:US
Practice Address - Phone:732-545-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03369600207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53999Medicare UPIN
NJ572095CSLMedicare ID - Type Unspecified