Provider Demographics
NPI:1841592862
Name:DIKE, CHINEDU MANASSEH
Entity Type:Individual
Prefix:
First Name:CHINEDU
Middle Name:MANASSEH
Last Name:DIKE
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 1:21 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-2322
Mailing Address - Country:US
Mailing Address - Phone:718-813-2526
Mailing Address - Fax:
Practice Address - Street 1:21 LAUREL DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-2322
Practice Address - Country:US
Practice Address - Phone:718-813-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299569164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse