| Doctor Name: | ELIZABETH STEWART |
| NPI Number: | 1982069860 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 404 Potter Blvd Brightwaters, NY - 117181830 |
| Business Phone Number: | 6313760055 |
| Business Fax Number: | |
| Mailing Address: | 23 Roosevelt Dr, BETHPAGE |
| State: | NY |
| Postal Code: | 117145537 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/21/2015 |
| NPI Last Update Date: | 12/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |