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Individual

MR. JOHN DISTASIO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.A., ED., S.A.S.

Contact information

Practice address
6 E 85TH ST, NEW YORK, NY 10028-0419
(212) 249-3806
(212) 249-3786
Mailing address
6 E 85TH ST, NEW YORK, NY 10028-0419
(212) 249-3806
(212) 249-3786

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
638857951
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
NONE
NONE
Enumeration date
03/25/2019
Last updated
03/25/2019
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