Individual
IRENA DISTASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
134 ATLANTIC AVE, BROOKLYN, NY 11201-5502
(718) 780-2818
Mailing address
450 CLARKSON AVE, BROOKLYN, NY 11203-2012
(718) 270-1638
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
002123
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02904974
—
NY
Enumeration date
03/07/2008
Last updated
07/02/2014
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