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

Last updated

Jul 16, 2013By the provider in NPPES

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

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.

• Care Connect Medical P.C.

  • General Practice Physician
  • Tarrytown, NY
  • NPI 1457032328
  Medicare reassignment NPD
• Family Choice of New York Medical PC

  • General Practice Physician
  • Depew, NY
  • NPI 1720312754
  Medicare reassignment NPD
• Mobile Physician Services PLLC

  • Family Medicine Physician
  • Buffalo, NY
  • NPI 1194132415
  Medicare reassignment NPD
• Physician Mobile Medical Care PC

  • Internal Medicine Physician
  • Buffalo, NY
  • NPI 1518765502
  Medicare reassignment NPD
• Trinity Medical Wny PC

  • Internal Medicine Physician
  • Buffalo, NY
  • NPI 1295043149

  Adult Health

  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.

• Adult Health Nurse Practitioner in Depew, NY
• Providers in Depew, NY by specialty
• 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.