Provider Demographics
NPI:1205975802
Name:DR. KEVIN P. STEWART, M.D. OPHTHALMOLOGY P.L.L.C.
Entity type:Organization
Organization Name:DR. KEVIN P. STEWART, M.D. OPHTHALMOLOGY P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHARIS
Authorized Official - Middle Name:RIEVE
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-763-2263
Mailing Address - Street 1:117 E 7TH ST
Mailing Address - Street 2:1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-5743
Mailing Address - Country:US
Mailing Address - Phone:646-763-2263
Mailing Address - Fax:212-533-0741
Practice Address - Street 1:117 E 7TH ST
Practice Address - Street 2:1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-5743
Practice Address - Country:US
Practice Address - Phone:646-763-2263
Practice Address - Fax:212-533-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226054207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02621814Medicaid
NYWSP311Medicare PIN
NYI20989Medicare UPIN