Provider Demographics
NPI:1972743607
Name:HEWITT, MICHAEL G (D O)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:HEWITT
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1006 MANTUA PIKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1228
Mailing Address - Country:US
Mailing Address - Phone:856-686-8282
Mailing Address - Fax:856-686-8280
Practice Address - Street 1:1006 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1228
Practice Address - Country:US
Practice Address - Phone:856-686-8282
Practice Address - Fax:856-686-8280
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0165052085R0202X
NJ25MB107515002085R0202X
DEC2-00102242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology