Provider Demographics
NPI:1326264185
Name:BAIS, PAMMI T (MD)
Entity Type:Individual
Prefix:
First Name:PAMMI
Middle Name:T
Last Name:BAIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 APPLEGARTH RD
Mailing Address - Street 2:STE 11
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831
Mailing Address - Country:US
Mailing Address - Phone:609-409-2400
Mailing Address - Fax:609-409-2404
Practice Address - Street 1:357 APPLEGARTH RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831
Practice Address - Country:US
Practice Address - Phone:609-409-2400
Practice Address - Fax:609-409-2404
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
635426Medicare UPIN
BA893090Medicare PIN