Provider Demographics
NPI:1174820948
Name:SESTOK, JENNIFER ERIN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ERIN
Last Name:SESTOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N BARRY AVE APT 3I
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1654
Mailing Address - Country:US
Mailing Address - Phone:732-485-2486
Mailing Address - Fax:
Practice Address - Street 1:501 N BARRY AVE APT 3I
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1654
Practice Address - Country:US
Practice Address - Phone:732-485-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021157-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist