Individual
MS. CATHY DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OMT
Contact information
Practice address
5 WIMBLEDON CT, WOODBURY, NY 11797-2411
(516) 510-1157
Mailing address
5 WIMBLEDON CT, WOODBURY, NY 11797-2411
(516) 510-1157
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
018374
NY
124Q00000X
Dental Hygienist
018374-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018374
OMT
NY
05
—
018374
—
NY
05
—
018374-1
—
NY
05
—
9478748
—
NY
Enumeration date
02/09/2018
Last updated
06/16/2018
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