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General NPI Number Information
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NPI Number | 1164793089
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Entity Type | Organization
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Legal Business Name | WILLIAM B. HEAD JR. M.D. P.C.
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 1100 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3648
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Country | US
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Telephone | 718-448-5554
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Fax | 718-448-6741
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Provider Business Mailing Address
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Address Line | 1100 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-3648
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Country | US
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Telephone | 718-448-5554
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Fax | 718-448-6741
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. WILLIAM B. HEAD JR.
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Credential | M.D.
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Telephone | 718-448-5554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 25MA02586900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA02586900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 109042
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 109042
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License Number State | NY
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