Healthcare Provider Details

I. General information

NPI: 1639541774
Provider Name (Legal Business Name): ERIC EDWARD SILK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18114 N GOLDENRIDGE WAY
BOISE ID
83714-8885
US

IV. Provider business mailing address

18114 N GOLDENRIDGE WAY
BOISE ID
83714-8885
US

V. Phone/Fax

Practice location:
  • Phone: 646-431-8084
  • Fax:
Mailing address:
  • Phone: 646-431-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number526
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number526
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: