Healthcare Provider Details

I. General information

NPI: 1457322000
Provider Name (Legal Business Name): CHRISTINA KAECKER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ROUTE 31
FLEMINGTON NJ
08822-5795
US

IV. Provider business mailing address

111 STATE ROUTE 31 STE 111
FLEMINGTON NJ
08822-4953
US

V. Phone/Fax

Practice location:
  • Phone: 908-284-9880
  • Fax: 908-782-4316
Mailing address:
  • Phone: 908-284-9880
  • Fax: 908-782-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00124900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: