MEDICARE: DR. ERIC B NESBITT PH D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	07373 1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326026188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC B NESBITT PH D

Provider Business Mailing Address
First Line	:	333 METRO PARK STE M104
Second Line	:	ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2632
Country	:	US
Telephone Number	:	585-272-7853
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 METRO PARK STE M104
Second Line	:	ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14623-2632
Country	:	US
Telephone Number	:	585-272-7853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	02/15/2008

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