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Individual
WILLIAM DESTEFANO
Active
Individual
WILLIAM DESTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
163360
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015618
GHI
NY
05
—
00912134
—
NY
01
—
WD049D7110
EMPIRE BLUE CROSS BLUE SHIELD
NY
Enumeration date
05/12/2006
Last updated
05/07/2012
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