Kelly Distefano, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MA08068600 Issued in NJ

Practice address

619 River Dr
Elmwood Park, NJ 07407-1317

Phone

(201) 703-2900

NPI assigned

Jun 4, 2006

Last updated

Jul 24, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

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 1

Specialty

Anesthesiology

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Resolute Perioperative Services LLCGroup PAC ID 9436546041, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Resolute Perioperative Services LLC

  • Anesthesiology Physician
  • Livingston, NJ
  • NPI 1114686326
  Medicare reassignment Care Compare group NPD
• James Marc Schlesinger MD PC

  • Anesthesiology Physician
  • Toms River, NJ
  • NPI 1700265915
  Medicare reassignment NPD
• North American Partners in Anesthesia of New Jersey LLC

  • Anesthesiology Physician
  • Brick, NJ
  • NPI 1548433048
  NPD
• County Wide Anesthesia Group, LLC

  • Specialist
  • Paterson, NJ
  • NPI 1568465979
  NPD (past)
• Gastroenterology Diagnostics of Northern New Jersey, PA

  • Ambulatory Surgical Clinic/Center
  • Woodland Park, NJ
  • NPI 1942267893
  NPD (past)
• Hasbrouck Heights Rehab, LLC

  • Anesthesiology Physician
  • Clifton, NJ
  • NPI 1306139316
  NPD (past)
• Montclair Anesthesia Associates, P.C.

  • Anesthesiology Physician
  • Montclair, NJ
  • NPI 1841245628
  NPD (past)
• Tri-County Pain Management & Rehabilitation, PA

  • Anesthesiology Physician
  • Kearny, NJ
  • NPI 1194760801
  NPD (past)
• Orthopedic & Hand Specialists, PC

  • Orthopaedic Surgery Physician
  • Bala Cynwyd, PA
  • NPI 1285829358
  NPD (past)

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1679511000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1849",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042411849",
            "telephone_number": "207-784-2554",
            "fax_number": "207-777-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 RIVER DR",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071317",
            "telephone_number": "201-703-2900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1037 Route 46",
            "address_2": "Suite G5",
            "address_purpose": "LOCATION",
            "city": "Clifton",
            "state": "NJ",
            "postal_code": "070132451",
            "country_code": "US",
            "telephone_number": "973-928-5360",
            "fax_number": "973-928-5358",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "475 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "West Orange",
            "state": "NJ",
            "postal_code": "070524197",
            "country_code": "US",
            "telephone_number": "973-325-6716",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1037 Route 46",
            "address_2": "Suite G5",
            "address_purpose": "LOCATION",
            "city": "Clifton",
            "state": "NJ",
            "postal_code": "070132451",
            "country_code": "US",
            "telephone_number": "973-928-5360",
            "fax_number": "973-928-5358",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "562 Easton Ave",
            "address_purpose": "LOCATION",
            "city": "Somerset",
            "state": "NJ",
            "postal_code": "088731900",
            "country_code": "US",
            "telephone_number": "732-828-5900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DISTEFANO",
        "first_name": "KELLY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-04",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NJ",
            "license": "MA08068600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0114219",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Steven H Dane, M.D.
• Mahlik Davis
• Laura Del Corso, RPH
• Arlene Del Rosario, PHARMD
• Direct Emergency Medical Services LLC
• Thomas Dodd, L.C.A.D.C., C.S.W.
• Gregory I Dubover, D.D.S.
• Sheila Dunnells, PH.D., ADDICTIONS
• Taiel Durity-Choonoo
• Eastern Dental of Elmwood Park, LLC

• Anesthesiology Physician in Elmwood Park, NJ
• Providers in Elmwood Park, NJ by specialty
• Anesthesiology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.