Individual
DR. DOUGLAS CRAIG DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1190 5TH AVE, NEW YORK, NY 10029-6503
(212) 427-1540
(212) 410-7196
Mailing address
1185 PARK AVE APT 1L, NEW YORK, NY 10128-1307
(212) 427-6101
(212) 427-6128
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
127858
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00349606
—
NY
Enumeration date
02/12/2007
Last updated
05/05/2021
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