MRS. Jody Leigh Destefano

NPI #1912261488 in Lake Grove, New York

Provider Information

NPI Number: 1912261488
Entity Type: Individual
Name: MRS. Jody Leigh Destefano
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Jun 29, 2012
Last Updated: Jun 29, 2012

Practice Location

Address: 9 LINDELL AVE
City: Lake Grove
State: New York
ZIP Code: 11755-3121
Phone: (631) 285-1086

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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