Healthcare Provider Details

I. General information

NPI: 1447294046
Provider Name (Legal Business Name): KEVIN HEWITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE ETD
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

115 MONTAGUE ST 3C
BROOKLYN NY
11201
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-4614
  • Fax: 201-968-1866
Mailing address:
  • Phone: 201-996-4614
  • Fax: 201-968-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMA05889200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: