Healthcare Provider Details

I. General information

NPI: 1255325825
Provider Name (Legal Business Name): PAMELA J MADEJ ANP, RN, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 EVERETT RD
ALBANY NY
12205-1427
US

IV. Provider business mailing address

116 EVERETT RD
ALBANY NY
12205-1427
US

V. Phone/Fax

Practice location:
  • Phone: 518-463-0171
  • Fax: 518-463-0174
Mailing address:
  • Phone: 518-463-0171
  • Fax: 518-463-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberF30236601
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3023661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: