Provider Demographics
NPI:1629671664
Name:INYANG, IDONGESIT U
Entity Type:Individual
Prefix:
First Name:IDONGESIT
Middle Name:U
Last Name:INYANG
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 1:1 DONLONTON CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08515-9786
Mailing Address - Country:US
Mailing Address - Phone:848-228-1667
Mailing Address - Fax:
Practice Address - Street 1:1 DONLONTON CIR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08515-9786
Practice Address - Country:US
Practice Address - Phone:848-228-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-45998103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst