Healthcare Provider Details

I. General information

NPI: 1588712467
Provider Name (Legal Business Name): MICHAEL S. STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 GRAND ST
JERSEY CITY NJ
07302-4238
US

IV. Provider business mailing address

PO BOX 367
MENDHAM NJ
07945-0367
US

V. Phone/Fax

Practice location:
  • Phone: 201-915-2600
  • Fax: 201-369-6301
Mailing address:
  • Phone: 973-885-2210
  • Fax: 973-895-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMA70899
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: