Distefano, Kelly
Distefano, Kelly is an individual health care provider with primary practice located at 619 River Dr , Elmwood Park NJ 07407-1317. She recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as her primary health care specialty. Distefano, Kelly can be contacted via phone (201) 703-2900.Contact Information
Primary practice address
619 River Dr
Elmwood Park NJ 07407-1317
Phone: (201) 703-2900
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | MA08068600 | New Jersey |
Profile Details
| NPI number | 1679511000 |
|---|---|
| LBN Legal business name | Distefano, Kelly |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 4th, 2006 |
| Last updated | Jul 24th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679511000 | NPPES |
| New Jersey | MEDICAID | PENDING | |
| New Jersey | MEDICAID | 0114219 |
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