Provider Demographics
NPI:1639333891
Name:BORMAN, PAMELA B (LIC AC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:B
Last Name:BORMAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 UPPER MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1437
Mailing Address - Country:US
Mailing Address - Phone:973-746-0241
Mailing Address - Fax:
Practice Address - Street 1:378 UPPER MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1437
Practice Address - Country:US
Practice Address - Phone:973-746-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235871171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist