Healthcare Provider Details

I. General information

NPI: 1598618373
Provider Name (Legal Business Name): ERIC ANDERSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAPLE SHADE RD
RIDGEFIELD CT
06877-3828
US

IV. Provider business mailing address

52 DANBURY RD STE 242
RIDGEFIELD CT
06877-4019
US

V. Phone/Fax

Practice location:
  • Phone: 917-687-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.016432
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: