Healthcare Provider Details

I. General information

NPI: 1649469859
Provider Name (Legal Business Name): NEIL NEWBERG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5474 LAKE HOWELL RD
WINTER PARK FL
32792-1036
US

IV. Provider business mailing address

5474 LAKE HOWELL RD
WINTER PARK FL
32792-1036
US

V. Phone/Fax

Practice location:
  • Phone: 407-679-3400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME13363
License Number StateFL

VIII. Authorized Official

Name: NEIL NEWBERG
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 407-679-3400