Provider Demographics
NPI:1992289227
Name:AIKHAITUAMEN, HENRY
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:AIKHAITUAMEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 HUNTERDON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2412
Mailing Address - Country:US
Mailing Address - Phone:973-932-4679
Mailing Address - Fax:
Practice Address - Street 1:1035 HUNTERDON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2412
Practice Address - Country:US
Practice Address - Phone:973-932-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst