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General NPI Number Information
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NPI Number | 1669851267
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Entity Type | Individual
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Provider Name | ETHAN A. IKELER H.I.S.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 596 SECOND STREET
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City | NORTHUMBERLAND
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State | PA
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Zip | 17857-1262
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Country | US
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Telephone | 570-473-1200
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Fax | 570-473-3300
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Provider Business Mailing Address
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Address Line | 596 SECOND STREET
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City | NORTHUMBERLAND
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State | PA
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Zip | 17857-1262
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Country | US
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Telephone | 570-473-1200
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Fax | 570-473-3300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | F03393
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License Number State | PA
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