Provider Demographics
NPI:1326162009
Name:BUCKALEW, PAMELA (APN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BUCKALEW
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SAFRAN AVE
Mailing Address - Street 2:ATTENTION: S. GILL
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3510
Mailing Address - Country:US
Mailing Address - Phone:732-646-4163
Mailing Address - Fax:732-738-6017
Practice Address - Street 1:288 RUES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5699
Practice Address - Country:US
Practice Address - Phone:732-257-6100
Practice Address - Fax:732-651-9834
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC06070300163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ820327Medicare ID - Type UnspecifiedMEDICARE PROVIDER #