Individual
DR. KENNETH LOUIS DISTEFANO
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
207Q00000X
Family Medicine Physician
255630-1
NY
207Q00000X
Family Medicine Physician
Primary
25MA08855100
NJ
Other
Enumeration date
02/25/2008
Last updated
01/05/2011
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