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Organization
MICHAEL DISTEFANO, M.D., P.A.
Active
Organization
MICHAEL DISTEFANO, M.D., P.A.
Active
Parent organization
MICHAEL DISTEFANO, M .D., P.A.
Other names
Michael Distefano, M.D., P.A., Department of Physical Therapy
Organization subpart
Yes
Provider details
NPI number
Legal business name
MICHAEL DISTEFANO, M .D., P.A.
Authorized official
MRS. MARYANNE VITIELLO (PRACTICE MANAGER)
(201) 261-5501
Entity
Organization
Contact information
Practice address
140 N RTE 17, SUITE 205, PARAMUS, NJ 07652-2809
(201) 261-5501
(201) 261-3350
Mailing address
140 N RTE 17, SUITE 205, PARAMUS, NJ 07652-2809
(201) 261-5501
(201) 261-3350
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2251X0800X
Orthopedic Physical Therapist
—
NULL
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
01/26/2011
Last updated
06/10/2011
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