Individual
DR. SUSAN DISTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3713 E TREMONT AVE, BRONX, NY 10465-2054
(718) 792-4878
Mailing address
8717 17TH AVE, BROOKLYN, NY 11214-4546
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
271109
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2009
Last updated
08/12/2014
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