Provider Demographics
NPI:1043299894
Name:HEWLETT, DIAL (MD)
Entity type:Individual
Prefix:
First Name:DIAL
Middle Name:
Last Name:HEWLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 EASTCHESTER RD
Mailing Address - Street 2:MEDICAKL STAFF OFFICES
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2300
Mailing Address - Country:US
Mailing Address - Phone:914-330-3747
Mailing Address - Fax:
Practice Address - Street 1:1740 EASTCHESTER RD
Practice Address - Street 2:MEDICAKL STAFF OFFICES
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2300
Practice Address - Country:US
Practice Address - Phone:914-330-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138794207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00797264Medicaid
B17386Medicare UPIN
NY64A292Medicare ID - Type Unspecified