Provider Demographics
NPI:1891853578
Name:KENDALL STEWART DPM, PC
Entity Type:Organization
Organization Name:KENDALL STEWART DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:BASIL
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-284-3982
Mailing Address - Street 1:4016 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2917
Mailing Address - Country:US
Mailing Address - Phone:718-284-3982
Mailing Address - Fax:718-284-2881
Practice Address - Street 1:4016 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2917
Practice Address - Country:US
Practice Address - Phone:718-284-3982
Practice Address - Fax:718-284-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03320213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0083119OtherGHI
NY00645381Medicaid
NY0083119OtherGHI
NYT32125Medicare UPIN