Healthcare Provider Details

I. General information

NPI: 1245009463
Provider Name (Legal Business Name): PAMELA R MACIROWSKI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MAIN ST STE 1
FARMINGDALE NJ
07727-1341
US

IV. Provider business mailing address

271 GROVE AVE STE E
VERONA NJ
07044-1730
US

V. Phone/Fax

Practice location:
  • Phone: 732-938-6471
  • Fax: 833-488-1209
Mailing address:
  • Phone: 973-559-3700
  • Fax: 833-484-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number26NR21841000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15005300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: