Provider Demographics
NPI:1992189922
Name:DE STEFANO, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:DE STEFANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 RICHMOND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3937
Mailing Address - Country:US
Mailing Address - Phone:718-477-0961
Mailing Address - Fax:
Practice Address - Street 1:2025 RICHMOND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3937
Practice Address - Country:US
Practice Address - Phone:718-477-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist