=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497861462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAMELA C. TOLA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2089 KLOCKNER RD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-588-5474
-----------------------------------------------------
Fax | 609-588-4949
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2089 KLOCKNER RD
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-3416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-588-5474
-----------------------------------------------------
Fax | 609-588-4949
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PODIATRIST
-----------------------------------------------------
Name | DR. PAMELA C. TOLA
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 609-588-5474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 25MD00210400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------