Provider Demographics
NPI:1679547004
Name:DUKE, PAMELA (ANPC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:DUKE
Suffix:
Gender:F
Credentials:ANPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-294-2666
Mailing Address - Fax:732-431-8267
Practice Address - Street 1:901 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-294-2666
Practice Address - Fax:732-431-8267
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR94455363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7461402Medicaid
NJ7897405Medicaid
NJS750000Medicare UPIN
NJ005191Medicare ID - Type UnspecifiedMEDICARE GROUP
NJ086452LOFMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL