Healthcare Provider Details

I. General information

NPI: 1417916131
Provider Name (Legal Business Name): DAVID M. STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 HILLSDALE AVE
HILLSDALE NJ
07642-2212
US

IV. Provider business mailing address

297 HILLSDALE AVE
HILLSDALE NJ
07642-2212
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-2110
  • Fax: 201-666-4243
Mailing address:
  • Phone: 201-666-2110
  • Fax: 201-666-4243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA02706100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: