Provider Demographics
NPI:1780863514
Name:NEIL F. NEIMARK, M.D. INC.
Entity Type:Organization
Organization Name:NEIL F. NEIMARK, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:F
Authorized Official - Last Name:NEIMARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-502-5656
Mailing Address - Street 1:4980 BARRANCA PKWY
Mailing Address - Street 2:#207
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8645
Mailing Address - Country:US
Mailing Address - Phone:949-502-5656
Mailing Address - Fax:949-502-5647
Practice Address - Street 1:4980 BARRANCA PKWY
Practice Address - Street 2:#207
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8645
Practice Address - Country:US
Practice Address - Phone:949-502-5656
Practice Address - Fax:949-502-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19361Medicare PIN