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General NPI Number Information
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NPI Number | 1336301977
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Entity Type | Individual
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Provider Name | PAMELA MUKHATIYAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 703 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2621
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Country | US
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Telephone | 973-754-2550
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Fax | 973-972-5895
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Provider Business Mailing Address
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Address Line | 703 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2621
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Country | US
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Telephone | 973-754-2550
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Fax | 973-972-5895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 25MA09683800
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License Number State | NJ
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