MEDICARE: AGAVE MEDICAL NJ PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1619859238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGAVE MEDICAL NJ PC

Provider Business Mailing Address
First Line	:	359 5TH ST UNIT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-2329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 5TH ST UNIT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-2329
Country	:	US
Telephone Number	:	929-209-6109
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ORI FRUHAUF
Credential	:
Telephone Number	:	551-302-1794

Provider Enumeration Date	:	07/24/2025
Last Update Date	:	07/24/2025

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Directions to “AGAVE MEDICAL NJ PC ” Practice Location

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