Provider Demographics
NPI:1255325825
Name:MADEJ, PAMELA J (ANP, RN, MS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:MADEJ
Suffix:
Gender:F
Credentials:ANP, RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1427
Mailing Address - Country:US
Mailing Address - Phone:518-463-0171
Mailing Address - Fax:518-463-0174
Practice Address - Street 1:116 EVERETT RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1427
Practice Address - Country:US
Practice Address - Phone:518-463-0171
Practice Address - Fax:518-463-0174
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF30236601163WP0000X
NYF3023661363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000497460001OtherBSNENY
NY500023660OtherRAIL ROAD MEDICARE
NY347727OtherMVP
NYP05917Medicare UPIN
NY347727OtherMVP
NY500023660OtherRAIL ROAD MEDICARE