Provider Demographics
NPI:1922338458
Name:HEWITT, EDWIN GEORGE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:GEORGE
Last Name:HEWITT
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEWKIRT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7309
Mailing Address - Country:US
Mailing Address - Phone:631-587-4736
Mailing Address - Fax:
Practice Address - Street 1:30 NEWKIRT AVE
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7309
Practice Address - Country:US
Practice Address - Phone:631-806-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004213-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist