Provider Demographics
NPI:1821211285
Name:NEAL MAREK, DPM PROFESSINAL CORPORATION
Entity Type:Organization
Organization Name:NEAL MAREK, DPM PROFESSINAL CORPORATION
Other - Org Name:AMBULATORY SURGERY CENTER OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-438-8417
Mailing Address - Street 1:4631 E CHARLESTON BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5746
Mailing Address - Country:US
Mailing Address - Phone:702-438-8417
Mailing Address - Fax:702-453-1962
Practice Address - Street 1:4631 E CHARLESTON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5746
Practice Address - Country:US
Practice Address - Phone:702-438-8417
Practice Address - Fax:702-453-1962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV455-ASC-9261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
9C0001030Medicare ID - Type Unspecified