1417121260 NPI number — DANIELA LILIANA NEAGU MD

Table of content: (NPI 1851366850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417121260 NPI number — DANIELA LILIANA NEAGU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEAGU
Provider First Name:
DANIELA
Provider Middle Name:
LILIANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417121260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40767
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32203-0767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-376-3707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 PRUDENTIAL DR STE 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32207-8350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-202-8550
Provider Business Practice Location Address Fax Number:
904-393-7808
Provider Enumeration Date:
04/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , with the licence number:  FT42377 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: 25MA07770400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: TRN9235 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: ME112644 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14K20 . This is a "BCBSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8L3849 . This is a "MEDICARE CMS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 004777200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003123602A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 198967501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004777200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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