Provider Demographics
NPI:1245977966
Name:PASSLEY, ALECIA
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:PASSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4514
Mailing Address - Country:US
Mailing Address - Phone:848-234-7588
Mailing Address - Fax:
Practice Address - Street 1:136 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4514
Practice Address - Country:US
Practice Address - Phone:848-234-7588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ88-1209324OtherHAIR EXTENSION AND CUSTOMIZED WIGS