Provider Demographics
NPI:1780579110
Name:DR TODD NEWBERG PLLC
Entity type:Organization
Organization Name:DR TODD NEWBERG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:NEWBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-252-4199
Mailing Address - Street 1:255 N LAKEMONT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3210
Mailing Address - Country:US
Mailing Address - Phone:407-490-1022
Mailing Address - Fax:407-490-1023
Practice Address - Street 1:255 N LAKEMONT AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3210
Practice Address - Country:US
Practice Address - Phone:407-490-1022
Practice Address - Fax:407-490-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty