Healthcare Provider Details

I. General information

NPI: 1952493488
Provider Name (Legal Business Name): WILLIAM JOSPEH STEWART DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE LONG ISLAND JEWSIH MEDICAL CENTER
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

270-05 76TH AVE LONG ISLAND JEWSIH MEDICAL CENTER
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7122
  • Fax: 718-347-3483
Mailing address:
  • Phone: 718-470-7122
  • Fax: 718-347-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number033625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: