Individual
DR. KENNETH L DISTEFANO SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MOUNT PROSPECT AVE, VERONA, NJ 07044-2707
(973) 239-7777
(973) 239-7082
Mailing address
1 MOUNT PROSPECT AVE, VERONA, NJ 07044-2707
(973) 239-7777
(973) 239-7082
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
25MA02454300
NJ
Other
Enumeration date
10/24/2006
Last updated
09/06/2023
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