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1124647631
MICHAEL DISTEFANO
STATEN ISLAND, NY
NPI
1124647631
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: NY 012677)
Enumeration Date
2020-04-14
Last Update Date
2020-04-14
Business Address
MICHAEL DISTEFANO
4711 HYLAN BLVD
STATEN ISLAND, NY 10312-6311
Phone number: 347-739-3778
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Mailing Address
MICHAEL DISTEFANO
4711 HYLAN BLVD
STATEN ISLAND, NY 10312-6311
Phone number: 347-739-3778
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