Healthcare Provider Details
I. General information
NPI: 1326401662
Provider Name (Legal Business Name): DARIA SERGEEVNA YUNINA-DISTEFANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/04/2016
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
33 OVERLOOK RD STE 201
SUMMIT NJ
07901-3562
US
IV. Provider business mailing address
PO BOX 416457
BOSTON MA
02241-0001
US
V. Phone/Fax
- Phone: 908-522-5040
- Fax: 908-522-5041
- Phone: 844-362-1735
- Fax: 973-290-7495
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | 2026-05108 |
| License Number State | NC |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RT0003X |
| Taxonomy | Transplant Hepatology Physician |
| License Number | 25MA11828100 |
| License Number State | NJ |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RT0003X |
| Taxonomy | Transplant Hepatology Physician |
| License Number | 2026-05108 |
| License Number State | NC |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: