Healthcare Provider Details

I. General information

NPI: 1700771482
Provider Name (Legal Business Name): AMANDA M KOVACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5418 N EAGLE RD STE 160
BOISE ID
83713-0100
US

IV. Provider business mailing address

10348 W ALTAIR DR
STAR ID
83669-5615
US

V. Phone/Fax

Practice location:
  • Phone: 973-897-2128
  • Fax:
Mailing address:
  • Phone: 973-897-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7381713
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: