Provider Demographics
NPI:1568053114
Name:A.M.C WHITE LLC
Entity Type:Organization
Organization Name:A.M.C WHITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:MATTHEW CIAZ
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:OD MHA
Authorized Official - Phone:917-341-3845
Mailing Address - Street 1:25 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-2207
Mailing Address - Country:US
Mailing Address - Phone:718-405-7211
Mailing Address - Fax:718-405-7599
Practice Address - Street 1:25 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-2207
Practice Address - Country:US
Practice Address - Phone:718-405-7211
Practice Address - Fax:718-405-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1528012333OtherPERSONAL NPI
NY01503153Medicaid