Provider Demographics
NPI:1417916131
Name:STEWART, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2212
Mailing Address - Country:US
Mailing Address - Phone:201-666-2110
Mailing Address - Fax:201-666-4243
Practice Address - Street 1:297 HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2212
Practice Address - Country:US
Practice Address - Phone:201-666-2110
Practice Address - Fax:201-666-4243
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02706100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD92541Medicare UPIN
ST461655Medicare ID - Type Unspecified