Cefalù was born in Palermo, Sicily in 1947. After moving to the United States, Cefalù got involved in organized crime and started smuggling heroin for the Gambino crime family. In 1982, he was convicted of heroin smuggling and served six years in prison. In 1991, Gambino boss John Gotti inducted Cefalù as a made man, or full member, into the Gambino family. Cefalù was a member of the Sicilian "Zip" crew headed by captain Pasquale Conte and based in Queens and Brooklyn. In 2015 he susposedly turned over control to Frank Cali.