Provider Demographics
NPI:1235566712
Name:WHITE, ANTHONY B (NURSE)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:B
Last Name:WHITE
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 ALBEMARLE RD
Mailing Address - Street 2:APT. 5N
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3988
Mailing Address - Country:US
Mailing Address - Phone:347-955-5570
Mailing Address - Fax:
Practice Address - Street 1:2111 ALBEMARLE RD
Practice Address - Street 2:APT. 5N
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3988
Practice Address - Country:US
Practice Address - Phone:347-955-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302263-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWY18877XMedicaid