Provider Demographics
NPI:1386819886
Name:FIUMECALDO, PAMELA J (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:FIUMECALDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-1414
Mailing Address - Country:US
Mailing Address - Phone:732-735-1943
Mailing Address - Fax:
Practice Address - Street 1:831 TENNENT RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8288
Practice Address - Country:US
Practice Address - Phone:732-536-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00149700363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical