Provider Demographics
NPI:1093223034
Name:ANATOL PODOLSKY MD INC
Entity Type:Organization
Organization Name:ANATOL PODOLSKY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANATOL
Authorized Official - Middle Name:
Authorized Official - Last Name:PODOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-6882
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 601
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7685
Mailing Address - Country:US
Mailing Address - Phone:949-644-6882
Mailing Address - Fax:949-644-2377
Practice Address - Street 1:18035 BROOKHURST ST STE 1200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6738
Practice Address - Country:US
Practice Address - Phone:949-644-6882
Practice Address - Fax:949-644-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty