Provider Demographics
NPI:1467676395
Name:STRUM, PAMELA CARNEVALE (MSTOM LAC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:CARNEVALE
Last Name:STRUM
Suffix:
Gender:F
Credentials:MSTOM LAC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:CARNEVALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSTOM LAC
Mailing Address - Street 1:16 SOUTH HARRISON STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-924-5358
Mailing Address - Fax:
Practice Address - Street 1:16 SOUTH HARRISON STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-924-5358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0027281171100000X
NJ171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist