Jason Distefano, DPT | |
389 Fort Salonga Rd, Northport, NY 11768-3089 | |
(631) 261-0444 | |
(631) 261-3112 |
Full Name | Jason Distefano |
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Gender | Male |
Speciality | Physical Therapist |
Location | 389 Fort Salonga Rd, Northport, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1609583145 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 050122 (New York) | Primary |
Provider Name | Ivyrehab Physical Therapy Pllc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1396799409 PECOS PAC ID: 7012997638 Enrollment ID: O20040723000705 |
Mailing Address | Practice Location Address |
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Jason Distefano, DPT 1311 Mamaroneck Ave Ste 140, White Plains, NY 10605-5224 Ph: () - | Jason Distefano, DPT 389 Fort Salonga Rd, Northport, NY 11768-3089 Ph: (631) 261-0444 |
Christine Foster, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 20 Woodhull Pl, Northport, NY 11768 Phone: 631-261-8606 | |
Erin Mary Imbasciani, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 40 Main St, Northport, NY 11768 Phone: 631-651-9623 Fax: 631-651-9421 | |
Melissa Cuda, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3 Middleville Rd, Northport, NY 11768 Phone: 631-235-5347 | |
Ejm Prestige Enterprise, Llc Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 68 Eatons Neck Rd, Northport, NY 11768 Phone: 516-242-5799 | |
Mr. Robert Joseph Znaniecki I, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 79 Middleville Rd, Northport, NY 11768 Phone: 631-261-4400 | |
Format Physical Therapy Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 16 Pocket Ct, Northport, NY 11768 Phone: 917-272-6375 | |
Carlos Alberto Montero, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 79 Middleville Rd, Northport, NY 11768 Phone: 631-261-4400 |