Active NPI
Charles Destefano, PH.D.
- Psychologist
- Staten Island, NY
National Provider Identifier
1710203393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 010175-1
- Practice address
- 77 Governor Rd
Staten Island, NY 10314-3021 - Phone
- (718) 273-9179
- Fax
- (718) 273-9179
- NPI assigned
- Apr 8, 2010
- Last updated
- Apr 8, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 010175-1 | NY | Primary |
Addresses
Primary practice location
77 Governor Rd
Staten Island, NY 10314-3021
Mailing address
77 Governor Rd
Staten Island, NY 10314-3021
Phone (718) 273-9179
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010175-1 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1710203393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "77 GOVERNOR RD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103143021",
"telephone_number": "718-273-9179",
"fax_number": "718-273-9179"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 GOVERNOR RD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103143021",
"telephone_number": "718-273-9179",
"fax_number": "718-273-9179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESTEFANO",
"first_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-08",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "010175-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.