Provider Demographics
NPI:1265574628
Name:DISTANO, ANTHONY CARMEN (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CARMEN
Last Name:DISTANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1925
Mailing Address - Country:US
Mailing Address - Phone:201-991-3854
Mailing Address - Fax:
Practice Address - Street 1:655 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2942
Practice Address - Country:US
Practice Address - Phone:201-991-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC006555500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor