Individual
JOANN DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
7 ELTON DR, EAST NORTHPORT, NY 11731-6007
(631) 766-0062
Mailing address
7 ELTON DRIVE, EAST NORTHPORT, NY 11731
(631) 766-0062
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
3453-1
NY
Other
Enumeration date
04/29/2009
Last updated
04/29/2009
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