Basic Information
| Provider Information | |||||||||
| NPI: | 1811369804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONNER | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | J | ||||||||
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| OtherLastName: | FELDMAN | ||||||||
| OtherFirstName: | PAMELA | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 484 TEMPLE HILL RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | NEW WINDSOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125535557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455653700 | ||||||||
| FaxNumber: | 8455653696 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 CRAIG RD | ||||||||
| Address2: | |||||||||
| City: | MANALAPAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077263250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324142991 | ||||||||
| FaxNumber: | 7324142995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2015 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00281500 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 008970 | 01 | NY | LICENSE NUMBER | OTHER | MA057455 | 01 | PA | LICENSE NUMBER | OTHER | 25MP00281500 | 01 | NJ | LICENSE NUMBER | OTHER |