Healthcare Provider Details

I. General information

NPI: 1790752012
Provider Name (Legal Business Name): DAVID J STEWART DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7203 164TH ST
FLUSHING NY
11365-4221
US

IV. Provider business mailing address

7203 164TH ST
FLUSHING NY
11365-4221
US

V. Phone/Fax

Practice location:
  • Phone: 718-591-3320
  • Fax: 718-591-4052
Mailing address:
  • Phone: 718-591-3320
  • Fax: 718-591-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: