Basic Information
| Provider Information | |||||||||
| NPI: | 1538590880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGECHA | ||||||||
| FirstName: | ALICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | RUTGERS BEHAVIORAL HEALTH CARE | ||||||||
| Address2: | 183 SOUTH ORANGE AVENUE | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725430 | ||||||||
| FaxNumber: | 9739727173 | ||||||||
| Practice Location | |||||||||
| Address1: | RUTGERS BEHAVIORAL HEALTH CARE | ||||||||
| Address2: | 183 SOUTH ORANGE AVENUE | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725430 | ||||||||
| FaxNumber: | 9739727173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2013 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 26NJ00474300 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.