Individual ProviderMichael DistefanoPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4711 Hylan Blvd, Staten Island, NY 10312-6311(347) 739-3778PECOS EnrollmentBased on the most recent information from CMS, provider Michael Distefano does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1124647631Provider TypeIndividualFull NameDistefano, MichaelGenderMaleSole ProprietorYesEnumeration Date4/14/2020Last Updated4/14/2020Contact InformationPractice LocationPractice Address4711 Hylan Blvd, Staten Island, NY 10312-6311Phone(347) 739-3778FaxUnlisted FaxMailing LocationMailing Address4711 Hylan Blvd, Staten Island, NY 10312-6311Phone(347) 739-3778FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense012677New York