Distefano, Leo Joseph

Distefano, Leo Joseph is an individual health care provider with primary practice located at 970 Farmington Avenue Suite 201, West Hartford CT 06107. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as his primary health care specialty. Distefano, Leo Joseph can be contacted via phone (860) 561-4300.

Contact Information

Primary practice address
970 Farmington Avenue Suite 201 West Hartford CT 06107
Phone: (860) 561-4300
Fax: (860) 561-1635
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 033656 Connecticut

Profile Details

NPI number 1760453724
LBN Legal business name Distefano, Leo Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Jul 8th, 2007 - about 18 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1760453724 NPPES
Connecticut Other 735010 CONNECTICARE
Connecticut MEDICAID 00133656100 CONNECTICARE
Connecticut Other 01003365CT01 CONNECTICARE

Popular Providers