Provider Demographics
NPI:1265416275
Name:FRUSTACE, JENNIFER ANN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:FRUSTACE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5233
Mailing Address - Country:US
Mailing Address - Phone:845-223-5507
Mailing Address - Fax:914-428-6013
Practice Address - Street 1:280 DOBBS FERRY RD
Practice Address - Street 2:209
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1900
Practice Address - Country:US
Practice Address - Phone:914-428-9698
Practice Address - Fax:914-428-6013
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023621-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ21C21Medicare ID - Type Unspecified