Provider Demographics
NPI:1598767865
Name:WHITE, BRIAN JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LIVINGSTON MNR
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1729
Mailing Address - Country:US
Mailing Address - Phone:914-674-0501
Mailing Address - Fax:914-674-0508
Practice Address - Street 1:27 LIVINGSTON MNR
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1729
Practice Address - Country:US
Practice Address - Phone:914-674-0501
Practice Address - Fax:914-674-0508
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02630739Medicaid
NY02630739Medicaid
NY127AB1Medicare ID - Type Unspecified