Healthcare Provider Details

I. General information

NPI: 1114842069
Provider Name (Legal Business Name): NANCHI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ELIZABETH AVE APT 402
NEWARK NJ
07112-4101
US

IV. Provider business mailing address

440 ELIZABETH AVE APT 402
NEWARK NJ
07112-4101
US

V. Phone/Fax

Practice location:
  • Phone: 929-840-4600
  • Fax:
Mailing address:
  • Phone: 929-840-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EGBICHI ANYA
Title or Position: MD
Credential:
Phone: 929-840-4600