Mary Grace Distefano, RN ANP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

306403 Issued in NY

Practice address

3332 Walden Ave Ste 110
Depew, NY 14043-2400

Phone

(716) 668-7051

NPI assigned

Jul 16, 2013

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Care Connect Medical P.C.

  • General Practice Physician
  • Tarrytown, NY
  • NPI 1457032328

  NY

  Medicare reassignment NPD
• Family Choice of New York Medical PC

  • General Practice Physician
  • Depew, NY
  • NPI 1720312754

  NY

  Medicare reassignment NPD
• Mobile Physician Services PLLC

  • Family Medicine Physician
  • Buffalo, NY
  • NPI 1194132415

  NY

  Medicare reassignment NPD
• Physician Mobile Medical Care PC

  • Internal Medicine Physician
  • Buffalo, NY
  • NPI 1518765502

  NY

  Medicare reassignment NPD
• Trinity Medical Wny PC

  • Internal Medicine Physician
  • Buffalo, NY
  • NPI 1295043149

  Adult Health, NY

  Medicare reassignment NPD
• Trinity Medical Wny PC

  • Vascular Surgery Physician
  • Buffalo, NY
  • NPI 1205468055
  NPD
• Trinity Medical Wny PC

  • Family Medicine Physician
  • Niagara Falls, NY
  • NPI 1508408998

  Adult Health

  NPD

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373932800000",
    "number": "1710328968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 PARK DR",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142216935",
            "telephone_number": "716-949-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3332 WALDEN AVE STE 110",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140432400",
            "telephone_number": "716-668-7051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTEFANO",
        "first_name": "MARY",
        "middle_name": "GRACE",
        "credential": "RN  ANP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "306403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Elise Desiderio
• Erika Dibartolomeo-Stachewicz
• Tina Marie Dibble
• Laura Dietz
• Loretta Teresa Dirienzo, RPH
• Ginamarie Divita
• Anthony Dobiesz, RPH
• Karin Lynn Dojnik, L.M.T.
• Jenna Louise Donati, MS, OTR/L
• Stuart L. Dorfman, M.D.

• All providers in Depew, NY
• Adult Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.