Individual
DONNA JEAN DESTASO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
910 SYLVAN AVE STE 100, ENGLEWOOD CLIFFS, NJ 07632-3308
(201) 569-2770
Mailing address
302 HOPPER CT, FRANKLIN LAKES, NJ 07417-1143
(201) 805-3763
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00579800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0947954
—
NJ
Enumeration date
07/22/2020
Last updated
12/26/2023
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