Healthcare Provider Details

I. General information

NPI: 1184537003
Provider Name (Legal Business Name): SCOTT AJI ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 WESTVILLE AVE
WEST CALDWELL NJ
07006-7434
US

IV. Provider business mailing address

265 WESTVILLE AVE
WEST CALDWELL NJ
07006-7434
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-6981
  • Fax:
Mailing address:
  • Phone: 973-228-6981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00152800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: