Provider Demographics
NPI:1720776263
Name:ANYAEGBU, NKECHINYERE DORIS
Entity Type:Individual
Prefix:
First Name:NKECHINYERE
Middle Name:DORIS
Last Name:ANYAEGBU
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 1:489 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2003
Mailing Address - Country:US
Mailing Address - Phone:973-393-6607
Mailing Address - Fax:
Practice Address - Street 1:220 DAVIDSON AVE STE 3063
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4149
Practice Address - Country:US
Practice Address - Phone:732-997-0707
Practice Address - Fax:732-907-0709
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01473100363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health