MEDICARE: NEWPORT BEACH SURGICAL AND MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207N00000X	Dermatology Physician
2	207YS0123X	Facial Plastic Surgery Physician
3	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1477953511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT BEACH SURGICAL AND MEDICAL GROUP INC

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	:	SUITE 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	:	PRESIDENT
Name	:	DR. SIMON J. MADORSKY
Credential	:	M.D.
Telephone Number	:	949-719-1800

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	12/04/2014

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Directions to “NEWPORT BEACH SURGICAL AND MEDICAL GROUP INC ” Practice Location

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