Michael Destefano, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

301867 Issued in NY

Practice address

75 N Country Rd
Port Jefferson, NY 11777-2119

Phone

(631) 473-1320

NPI assigned

Apr 19, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, CT, NJ, FL4 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 4

Specialty

Psychiatry

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aldad Medical PCGroup PAC ID 9234291436, 78 clinicians

John T Mather Memorial HospitalGroup PAC ID 1254237753, shared by 6 NPIs, 176 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H5989
• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aldad Medical PC

  • Psychiatry Physician
  • Ann Arbor, MI
  • NPI 1174784953

  CT, FL, NY

  Medicare reassignment Care Compare group NPD
• Aldad Medical NJ, P.C

  • Psychiatry Physician
  • Hoboken, NJ
  • NPI 1386238707
  Medicare reassignment NPD
• Aldad Medical PC

  • Psychiatry Physician
  • Stamford, CT
  • NPI 1750046512
  Medicare reassignment NPD
• John T. Mather Memorial Hospital

  • Psychiatry Physician
  • Port Jefferson Station, NY
  • NPI 1376642371
  Medicare reassignment
• John T. Mather Memorial Hospital

  • Critical Care Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1467249334
  Medicare reassignment
• John T Mather Memorial Hospital

  • Obesity Medicine (Internal Medicine) Physician
  • Port Jefferson, NY
  • NPI 1366816894
  NPD
• John T Mather Memorial Hospital

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Port Jefferson, NY
  • NPI 1922486182
  NPD
• John T. Mather Memorial Hospital

  • Diagnostic Radiology Physician
  • Port Jefferson, NY
  • NPI 1891816070
  NPD
• Aldad Medical PC

  • Psychiatry Physician
  • Boston, MA
  • NPI 1588310650
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1407200116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-473-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-473-1320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-19",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "301867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Marie Demaria
• Peter G Depasquale, PHD MSW
• Toni B Derman, LCSW
• Deborah M. Derosa, LCSW
• Tulsi Desai, PT
• Jessica Lynn Devereaux, R.D.
• Alejandra Devine, LMSW
• Stacey R Dewan
• Nitasha Dhiman
• Janet Dibartolo

• Psychiatry Physician in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.