Healthcare Provider Details

I. General information

NPI: 1013194711
Provider Name (Legal Business Name): VALAINE B HEWITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 KINGS HWY STE 3-04
BROOKLYN NY
11234-2644
US

IV. Provider business mailing address

3131 KINGS HWY STE 3-04
BROOKLYN NY
11234-2644
US

V. Phone/Fax

Practice location:
  • Phone: 215-933-0259
  • Fax: 215-933-3672
Mailing address:
  • Phone: 215-933-0259
  • Fax: 215-933-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number292948
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number292948
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: