Provider Demographics
NPI:1023289337
Name:STEWART, KENDALL (DPM)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003320-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00645381Medicaid
NY0083119OtherGHI
NY0083119OtherGHI
NY00645381Medicaid