Provider Demographics
NPI:1336161496
Name:DESTEFANO, SABRINA GLORIA (DO)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:GLORIA
Last Name:DESTEFANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12F DORADO DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-9413
Mailing Address - Country:US
Mailing Address - Phone:716-973-9988
Mailing Address - Fax:
Practice Address - Street 1:12F DORADO DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-9413
Practice Address - Country:US
Practice Address - Phone:716-973-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02798543Medicaid
NY02798543Medicaid