Individual
GINA LOUISE DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2875 BROADWAY, NEW YORK, NY 10025-7846
(929) 822-4165
Mailing address
1797 WASHINGTON ST, HOLLISTON, MA 01746-2239
(774) 573-6307
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
011050
NY
Other
Enumeration date
08/12/2024
Last updated
08/12/2024
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