Provider Demographics
NPI:1851576466
Name:DISTEFANO, JANET A (RPH)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:A
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1292 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-628-1900
Mailing Address - Fax:212-628-7200
Practice Address - Street 1:1292 FIRST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-628-1900
Practice Address - Fax:212-628-7200
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033888183500000X
NY33888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3358238OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY1568624278OtherNPI