Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | D12645 | NJ |
NPI | 1548226236 |
---|---|
Provider Name | Dr. Pamela Louise Alberto |
First Address | Sparta, NJ 07871 |
Second Address | Sparta, NJ 07871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2006 |
Last Update Date | 24/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165409 | (05) | NJ |
T77680 | (02) |