Provider Demographics
NPI:1164793089
Name:WILLIAM B. HEAD JR. M.D. P.C.
Entity Type:Organization
Organization Name:WILLIAM B. HEAD JR. M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-448-5554
Mailing Address - Street 1:1100 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3648
Mailing Address - Country:US
Mailing Address - Phone:718-448-5554
Mailing Address - Fax:718-448-6741
Practice Address - Street 1:1100 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3648
Practice Address - Country:US
Practice Address - Phone:718-448-5554
Practice Address - Fax:718-448-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1090422084N0400X, 2084P0800X
NJ25MA025869002084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY664111Medicare UPIN