MEDICARE: PAMELA J MADEJ ANP, RN, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0000X	Pain Management Registered Nurse	F30236601	NY
2	363LA2200X	Adult Health Nurse Practitioner	F3023661	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	500023660	OTHER	NY	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000497460001	OTHER	NY	BSNENY
3	347727	OTHER	NY	MVP

General Provider Information

NPI Number	:	1255325825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J MADEJ ANP, RN, MS

Provider Business Mailing Address
First Line	:	116 EVERETT RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1427
Country	:	US
Telephone Number	:	518-463-0171
Fax Number	:	518-463-0174

Provider Business Practice Location Address
First Line	:	116 EVERETT RD
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1427
Country	:	US
Telephone Number	:	518-463-0171
Fax Number	:	518-463-0174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	02/11/2011

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