Provider Demographics
NPI:1164512042
Name:GUTMAN, PAM M (RN, APN)
Entity type:Individual
Prefix:
First Name:PAM
Middle Name:M
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5792
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:DORRANCE 7TH FLOOR
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2265
Practice Address - Fax:856-342-8007
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJNR92499363LN0000X
NJNN92499363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K6367OtherHEALTHNET
NJ60027019OtherHORIZON NJ HEALTH
NJ42285OtherUNIVERSITY HEALTH PLAN
NJ010005547OtherAMERICHOICE
NJ0082767Medicaid
NJ2566419OtherUNITED HEALTHCARE