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Michael Distefano
NPI 1124647631 · on the registry since 2020 · sole proprietor
Practice
- Address
- 4711 Hylan Blvd
Staten Island, NY 10312 - Phone
- (347) 739-3778
- Clinicians at this address
- 2
Additional practice sites
- 4870 Hylan Blvd, Staten Island, NY
Registry record
- Primary taxonomy
- 225100000X
225100000X
- Licence states on file
- NY
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2020-04-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York