=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811789977
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIGMAUR HEWITT NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2025
-----------------------------------------------------
Last Update Date | 05/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 0909 HAZEN ST
-----------------------------------------------------
City | EAST ELMHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-774-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22334 112TH AVE
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11429-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-498-5243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | F405763-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------