Provider Demographics
NPI:1356447700
Name:NEIDORF, BARRY SHERWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:SHERWIN
Last Name:NEIDORF
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 1:2080 CENTURY PARK E., STE 1006
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2012
Mailing Address - Country:US
Mailing Address - Phone:310-277-2771
Mailing Address - Fax:310-277-5184
Practice Address - Street 1:2080 CENTURY PARK E., STE 1006
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2012
Practice Address - Country:US
Practice Address - Phone:310-277-2771
Practice Address - Fax:310-277-5184
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG20179AMedicare PIN
A89323Medicare UPIN