Provider Demographics
NPI:1598750408
Name:NEIMARK, PHYLLIS (MD)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:NEIMARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:NEIMARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 862233
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2233
Mailing Address - Country:US
Mailing Address - Phone:954-985-5846
Mailing Address - Fax:954-985-2451
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE-495
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-5846
Practice Address - Fax:954-985-2451
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL518112086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371903100Medicaid
FLC16984Medicare UPIN
FL07596WMedicare ID - Type Unspecified