Healthcare Provider Details

I. General information

NPI: 1306809595
Provider Name (Legal Business Name): ELIZABETH M. KUCHAR MBA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COLFAX AVE
CLIFTON NJ
07013-1701
US

IV. Provider business mailing address

239 MAIN ST
METUCHEN NJ
08840-2727
US

V. Phone/Fax

Practice location:
  • Phone: 973-420-2524
  • Fax:
Mailing address:
  • Phone: 732-713-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: