Provider Demographics
NPI:1497830210
Name:SCIBETTA, JANET ANN (PA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ANN
Last Name:SCIBETTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:ANN
Other - Last Name:CHUDZIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:11 HANNAH PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08087
Mailing Address - Country:US
Mailing Address - Phone:732-998-5115
Mailing Address - Fax:
Practice Address - Street 1:1100 ROUTE 72 W STE 306B
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2475
Practice Address - Country:US
Practice Address - Phone:609-978-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001841363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002265Medicare PIN
CTQ73494Medicare UPIN