Healthcare Provider Details

I. General information

NPI: 1447368022
Provider Name (Legal Business Name): EDWARD NEYMARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 BIRCH ST
NEWPORT BEACH CA
92660-1990
US

IV. Provider business mailing address

PO BOX 12139
NEWPORT BEACH CA
92658-5053
US

V. Phone/Fax

Practice location:
  • Phone: 949-629-2950
  • Fax: 949-606-8995
Mailing address:
  • Phone: 949-629-2950
  • Fax: 949-606-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA60093
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA60093
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberA60093
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberA60093
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA60093
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberA60093
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA60093
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA60093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: