Healthcare Provider Details

I. General information

NPI: 1831936236
Provider Name (Legal Business Name): PAMELA LIZETTE AYALA BALDEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 VALLEY RD STE 200
CLIFTON NJ
07013-2441
US

IV. Provider business mailing address

335 WOODLAND AVE
CHERRY HILL NJ
08002-2263
US

V. Phone/Fax

Practice location:
  • Phone: 844-666-2774
  • Fax: 201-392-3571
Mailing address:
  • Phone: 856-650-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: