Provider Demographics
NPI:1265081962
Name:WHITEHEAD, ERIC EDWARD (APN, MSN, RN)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:EDWARD
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:APN, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-5033
Mailing Address - Country:US
Mailing Address - Phone:201-841-9085
Mailing Address - Fax:
Practice Address - Street 1:225 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-5033
Practice Address - Country:US
Practice Address - Phone:201-841-9085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402785-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health