Provider Demographics
NPI:1306817630
Name:NESBETH, JANICE ROSEMARIE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ROSEMARIE
Last Name:NESBETH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:ROSEMARIE
Other - Last Name:DONDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1053 SAW MILL RIVER ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502
Mailing Address - Country:US
Mailing Address - Phone:914-693-2350
Mailing Address - Fax:914-693-7661
Practice Address - Street 1:657 E MAIN ST
Practice Address - Street 2:STE 3
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3424
Practice Address - Country:US
Practice Address - Phone:914-666-5550
Practice Address - Fax:845-278-4320
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023555-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP179Q11S1Medicare PIN
NYQP1791Medicare ID - Type UnspecifiedMEDICARE
NYA400156351Medicare PIN