Provider Type Icon

DR. SUSAN DISTASIO D.O. NPI 1700010410


NPI Information

NPI: 1700010410
Provider Name: DR. SUSAN DISTASIO, D.O.
Classification: Physical Medicine & Rehabilitation - 2081S0010X
Entity Type: Individual

Specialization: Sports Medicine

PECOS Registration: Yes

Address:
3713 E TREMONT AVE
BRONX, NY
ZIP 10465
Phone: (718) 792-4878
Get Directions

DR. Susan Distasio, D.O. is a sports medicine physical medicine rehabilitation in Bronx, NY with 16 years of experience. The provider is a physician who specializes in Sports Medicine is responsible for continuous care related to the enhancement of health and fitness as well as the prevention of injury and illness. The specialist possesses knowledge and experience in the promotion of wellness and the prevention of injury from many areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation and injuries. It is the goal of a Sports Medicine specialist to improve the healthcare of the individual engaged in physical exercise. DR. Susan Distasio, D.O. NPI is 1700010410. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
Graduation Year:2008

The provider's business location address is:

3713 E TREMONT AVE
BRONX, NY
ZIP 10465-054
Phone: (718) 792-4878

The NPI 1700010410 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/8/2009 and was last updated on 8/12/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12081S0010XPhysical Medicine & RehabilitationSports Medicine271109NEW YORKYes
2390200000XStudent in an Organized Health Care Education/Training ProgramNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.