Provider Demographics
NPI:1083415087
Name:STEWART, MOET
Entity type:Individual
Prefix:
First Name:MOET
Middle Name:
Last Name:STEWART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 SOUTH RD # 1029
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1360
Mailing Address - Country:US
Mailing Address - Phone:646-929-0443
Mailing Address - Fax:
Practice Address - Street 1:39 N PLANK RD STE 12
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2117
Practice Address - Country:US
Practice Address - Phone:646-926-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22ST1382708224P00000X
NY224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty