Eugene Joseph Destefano, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

040732-1 Issued in NY

Practice address

283 Hurley Ave
Kingston, NY 12401-2421

Phone

(845) 331-7089

Fax

(845) 331-7593

NPI assigned

Jul 31, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780690958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 HURLEY AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012421",
            "telephone_number": "845-331-7089",
            "fax_number": "845-331-7593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 HURLEY AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012421",
            "telephone_number": "845-331-7089",
            "fax_number": "845-331-7593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEFANO",
        "first_name": "EUGENE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "040732-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Vaught
• Kim E Denitto, O.T.A.
• Kelly S Dercola, MD
• Dermatology Services of Kingston P.C.
• John Joseph Derosalia, LCSW-R
• Michael Gerard Devine, LMSW
• Susan A Dewitt-Glickman, LCSW
• Dana Diacovo, REGISTERED NURSE
• Joseph Diacovo, DMD
• Nancy Ellen Dib

• General Practice Dentistry in Kingston, NY
• Providers in Kingston, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.