Healthcare Provider Details

I. General information

NPI: 1851389373
Provider Name (Legal Business Name): TONY DISTEFANO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MADISON AVE
MORRISTOWN NJ
07960-6092
US

IV. Provider business mailing address

234 STELTON ROAD
PISCATAWAY NJ
08854-3244
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-4300
  • Fax: 973-285-7618
Mailing address:
  • Phone: 732-968-9494
  • Fax: 732-968-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD002584
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00258400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: