Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Kenneth Louis Distefano, MD

Individual provider Family Medicine Physician · NPI 1619146677

Dr. Kenneth Louis Distefano, MD is a Family Medicine Physician in Verona, New Jersey. Practices as a sole proprietor. Licensed in New Jersey and New York.

Licensed in
NJ, NY
In the registry since
2008
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1 Mount Prospect Ave
Verona, NJ 07044-2707
Phone: (973) 239-7777
Fax: (973) 239-7082
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 25MA08855100 (NJ)
Family Medicine Physician Taxonomy 207Q00000X · Licence 255630-1 (NY)

Record details

NPI number1619146677
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedFebruary 25, 2008
Last updated in NPPESJanuary 5, 2011

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