Provider Demographics
NPI:1588807457
Name:WHITE, STACEY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:135 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2524
Mailing Address - Country:US
Mailing Address - Phone:516-385-1525
Mailing Address - Fax:516-385-1519
Practice Address - Street 1:135 WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2524
Practice Address - Country:US
Practice Address - Phone:516-385-1525
Practice Address - Fax:516-385-1519
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY199041-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation