Provider Demographics
NPI:1164209680
Name:IKE, NATHANIEL
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:IKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VALLEY FORGE DR
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-4228
Mailing Address - Country:US
Mailing Address - Phone:267-582-5765
Mailing Address - Fax:
Practice Address - Street 1:10 VALLEY FORGE DR
Practice Address - Street 2:
Practice Address - City:WOOLWICH TWP
Practice Address - State:NJ
Practice Address - Zip Code:08085-4228
Practice Address - Country:US
Practice Address - Phone:267-582-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health