# MICHAEL DISTEFANO, M.D., P.A.

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- **Entity:** Organization
- **Status:** 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:** 1902101710
- **Legal business name:** MICHAEL DISTEFANO, M .D., P.A.
- **Authorized official:** MRS. MARYANNE VITIELLO (PRACTICE MANAGER)
- **Authorized official phone:** (201) 261-5501

## Contact information

- **Practice address:** 140 N RTE 17, SUITE 205, PARAMUS, NJ 07652-2809
- **Practice address phone:** (201) 261-5501
- **Practice address fax:** (201) 261-3350
- **Mailing address:** 140 N RTE 17, SUITE 205, PARAMUS, NJ 07652-2809
- **Mailing address phone:** (201) 261-5501
- **Mailing address fax:** (201) 261-3350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 01/26/2011
- **Last updated:** 06/10/2011