Healthcare Provider Details

I. General information

NPI: 1578722245
Provider Name (Legal Business Name): HOWARD F. NEUDORF, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-2139 FORT WEAVER RD SUITE 213
EWA BEACH HI
96706-3607
US

IV. Provider business mailing address

94-830 LELEPUA ST APT A
WAIPAHU HI
96797-5124
US

V. Phone/Fax

Practice location:
  • Phone: 808-677-1912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number7199
License Number StateHI

VIII. Authorized Official

Name: HOWARD NEUDORF
Title or Position: PHYSICIAN
Credential:
Phone: 808-677-1912