Provider Demographics
NPI:1740267145
Name:NEUDORF, HOWARD
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:NEUDORF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-830 LELEPUA ST
Mailing Address - Street 2:A
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5124
Mailing Address - Country:US
Mailing Address - Phone:808-677-1912
Mailing Address - Fax:866-610-1585
Practice Address - Street 1:94-239 WAIPAHU DEPOT ST
Practice Address - Street 2:106
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3056
Practice Address - Country:US
Practice Address - Phone:808-677-1912
Practice Address - Fax:866-610-1585
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 7199207Q00000X
HI7199207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00915101Medicaid
HI0000BDZRRMedicare ID - Type Unspecified
HIF42500Medicare UPIN