MEDICARE: SIMON JOSEPH MADORSKY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	A50075	CA
2	207YS0123X	Facial Plastic Surgery Physician	A50075	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00002596	OTHER		RAILROAD MEDICARE
2	P01404246	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447259981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON JOSEPH MADORSKY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6765
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-6765
Country	:	US
Telephone Number	:	714-571-5000
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	180 NEWPORT CENTER DR
Second Line	:	158
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-6972
Country	:	US
Telephone Number	:	949-719-1800
Fax Number	:	949-719-1810

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	10/08/2015

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Directions to “ SIMON JOSEPH MADORSKY M.D.” Practice Location

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