MEDICARE: KENDALL STEWART DPM, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	03320	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0083119	OTHER	NY	GHI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891853578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDALL STEWART DPM, PC

Provider Business Mailing Address
First Line	:	4016 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2917
Country	:	US
Telephone Number	:	718-284-3982
Fax Number	:	718-284-2881

Provider Business Practice Location Address
First Line	:	4016 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2917
Country	:	US
Telephone Number	:	718-284-3982
Fax Number	:	718-284-2881

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. KENDALL BASIL STEWART
Credential	:	DPM
Telephone Number	:	718-284-3982

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	03/11/2008

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