Provider Demographics
NPI:1407952047
Name:WHITE, HANDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HANDEL
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W IVY LN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1614
Mailing Address - Country:US
Mailing Address - Phone:201-871-4162
Mailing Address - Fax:201-871-4162
Practice Address - Street 1:215 W 125TH ST
Practice Address - Street 2:2 ND FLOOR, RENAISSANCE HEALTH CARE NETWORK
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4426
Practice Address - Country:US
Practice Address - Phone:212-932-6518
Practice Address - Fax:212-316-1479
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13J571Medicare ID - Type Unspecified
NYG00964Medicare UPIN