Provider Demographics
NPI:1730236472
Name:BIRKY, IAN (PHD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:BIRKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-3062
Mailing Address - Country:US
Mailing Address - Phone:610-758-3880
Mailing Address - Fax:610-758-6207
Practice Address - Street 1:36 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-3062
Practice Address - Country:US
Practice Address - Phone:610-758-3880
Practice Address - Fax:610-758-6207
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005098L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS005098LOtherSTATE LICENSE NUMBER