Distefano, Kenneth Louis

Distefano, Kenneth Louis is an sole proprietor health care provider with primary practice located at 1 Mount Prospect Ave , Verona NJ 07044-2707. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Distefano, Kenneth Louis can be contacted via phone (973) 239-7777.

Contact Information

Primary practice address
1 Mount Prospect Ave Verona NJ 07044-2707
Phone: (973) 239-7777
Fax: (973) 239-7082
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 25MA08855100 New Jersey
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 255630-1 New York

Profile Details

NPI number 1619146677
LBN Legal business name Distefano, Kenneth Louis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 25th, 2008
Last updated Jan 5th, 2011 - about 14 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.

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