Provider Demographics
NPI:1629383682
Name:WHITE, GERALDINE G (PT, DPT, WCS)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:G
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT, DPT, WCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N CENTRAL AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1832
Mailing Address - Country:US
Mailing Address - Phone:914-357-3322
Mailing Address - Fax:914-214-5469
Practice Address - Street 1:280 N CENTRAL AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-357-3322
Practice Address - Fax:914-214-5469
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010252-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400053093Medicare PIN