Healthcare Provider Details

I. General information

NPI: 1730265547
Provider Name (Legal Business Name): PAMELA ZIMMITTI RAJKOWSKI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SICOMAC RD
NORTH HALEDON NJ
07508-2971
US

IV. Provider business mailing address

33 SICOMAC RD
NORTH HALEDON NJ
07508-2971
US

V. Phone/Fax

Practice location:
  • Phone: 973-427-7801
  • Fax: 973-427-7969
Mailing address:
  • Phone: 973-427-7801
  • Fax: 973-427-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number05358
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: