Individual
CANDICE DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
79 MIDDLEVILLE RD, NORTHPORT, NY 11768-2200
(631) 261-4400
Mailing address
627 HICKSVILLE RD, MASSAPEQUA, NY 11758-1241
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV008851-1
NY
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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