Provider Demographics
NPI:1043432255
Name:BIGELOW, PAMELA JANE (MSCPT, MTC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JANE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:MSCPT, MTC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JANE
Other - Last Name:BIGELOW-O'NEILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSCPT, MTC
Mailing Address - Street 1:82 TECUMSEH TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1616
Mailing Address - Country:US
Mailing Address - Phone:609-226-3600
Mailing Address - Fax:609-654-7493
Practice Address - Street 1:82 TECUMSEH TRL
Practice Address - Street 2:
Practice Address - City:MEDFORD LAKES
Practice Address - State:NJ
Practice Address - Zip Code:08055-1616
Practice Address - Country:US
Practice Address - Phone:609-226-3600
Practice Address - Fax:609-654-7493
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00310400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist