Provider Demographics
NPI:1386816411
Name:DISTELMAN, WILLIAM LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LESTER
Last Name:DISTELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 LINKS DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3076
Mailing Address - Country:US
Mailing Address - Phone:516-365-3877
Mailing Address - Fax:
Practice Address - Street 1:436 LINKS DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3076
Practice Address - Country:US
Practice Address - Phone:516-365-3877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0796402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry