Healthcare Provider Details

I. General information

NPI: 1598021636
Provider Name (Legal Business Name): RAE STEWART M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

440 SAINT JOHNS PL APT 3B
BROOKLYN NY
11238-5333
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number276989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: