Healthcare Provider Details

I. General information

NPI: 1033024294
Provider Name (Legal Business Name): AMANDA R KACZERSKI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ABERDEEN CIR
FLEMINGTON NJ
08822-1871
US

IV. Provider business mailing address

27 ABERDEEN CIR
FLEMINGTON NJ
08822-1871
US

V. Phone/Fax

Practice location:
  • Phone: 973-495-4828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00120000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: