Provider Demographics
NPI:1194585968
Name:RIBEIRO, PAMELA BASTOS (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:BASTOS
Last Name:RIBEIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KENVIL AVE
Mailing Address - Street 2:
Mailing Address - City:KENVIL
Mailing Address - State:NJ
Mailing Address - Zip Code:07847-2594
Mailing Address - Country:US
Mailing Address - Phone:862-432-5160
Mailing Address - Fax:
Practice Address - Street 1:425 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7732
Practice Address - Country:US
Practice Address - Phone:732-840-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program