Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | N003320-1 | NY |
NPI | 1023289337 |
---|---|
Provider Name | Kendall Stewart |
First Address | Brooklyn, NY 11203-2917 |
Second Address | Brooklyn, NY 11203-2917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2008 |
Last Update Date | 28/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00645381 | (05) | NY |
0083119 | GHI (01) | NY |
T32125 | (02) | NY |