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General NPI Number Information
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NPI Number | 1285280701
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Entity Type | Individual
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Provider Name | CHARLES KACZMARSKI PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 65 W JIMMIE LEEDS RD
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City | POMONA
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State | NJ
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Zip | 08240-9102
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Country | US
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Telephone | 609-345-4000
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Fax | 609-441-8178
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Provider Business Mailing Address
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Address Line | 65 W JIMMIE LEEDS RD
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City | POMONA
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State | NJ
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Zip | 08240-9102
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Country | US
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Telephone | 609-345-4000
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Fax | 609-441-8178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00591100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9114472
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License Number State | FL
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