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NPI 1790752012

NPI 1790752012 : DAVID J STEWART DPM : FLUSHING, NY

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General NPI Number Information
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    NPI Number           |    1790752012
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    Entity Type          |    Individual 
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    Provider Name        |    DAVID J STEWART DPM
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    03/06/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    7203 164TH ST 
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    City                 |    FLUSHING
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    State                |    NY
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    Zip                  |    11365-4221
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    Country              |    US
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    Telephone            |    718-591-3320
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    Fax                  |    718-591-4052
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Provider Business Mailing Address
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    Address Line         |    7203 164TH ST 
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    City                 |    FLUSHING
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    State                |    NY
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    Zip                  |    11365-4221
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    Country              |    US
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    Telephone            |    718-591-3320
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    Fax                  |    718-591-4052
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    213E00000X
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    Taxonomy Name        |    Podiatrist
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    License Number       |    N005255
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    License Number State |    NY
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