Provider Demographics
NPI:1740278522
Name:NEIMARK, SIDNEY (MD)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:NEIMARK
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 1:1117 N OLIVE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3520
Mailing Address - Country:US
Mailing Address - Phone:561-820-1441
Mailing Address - Fax:
Practice Address - Street 1:1117 N OLIVE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3520
Practice Address - Country:US
Practice Address - Phone:561-820-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068327200Medicaid
FL79844YMedicare PIN
FL068327200Medicaid