Healthcare Provider Details

I. General information

NPI: 1710713052
Provider Name (Legal Business Name): IAN ROBERT KAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KENNETT PIKE # 988
WILMINGTON DE
19807-2018
US

IV. Provider business mailing address

133 E CLEVELAND AVE
NEWARK DE
19711-2213
US

V. Phone/Fax

Practice location:
  • Phone: 484-577-9928
  • Fax:
Mailing address:
  • Phone: 609-694-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: