MEDICARE: DR. WILLIAM B HEAD JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	109042	NY
2	2084P0800X	Psychiatry Physician	25869	NJ

General Provider Information

NPI Number	:	1417013160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM B HEAD JR. MD

Provider Business Mailing Address
First Line	:	1100 CLOVE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3648
Country	:	US
Telephone Number	:	718-448-5554
Fax Number	:	718-448-6741

Provider Business Practice Location Address
First Line	:	1100 CLOVE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3648
Country	:	US
Telephone Number	:	718-448-5554
Fax Number	:	718-448-6741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	09/11/2025

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