Healthcare Provider Details

I. General information

NPI: 1073573077
Provider Name (Legal Business Name): GARY C STEWART D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEWARK POMPTON TPKE
RIVERDALE NJ
07457-1144
US

IV. Provider business mailing address

43 NEWARK POMPTON TPKE
RIVERDALE NJ
07457-1144
US

V. Phone/Fax

Practice location:
  • Phone: 973-835-5773
  • Fax:
Mailing address:
  • Phone: 973-835-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00272000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: