Provider Demographics
NPI:1801031620
Name:WHITE, TIMOTHY M (PA)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ALLWOOD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1933
Mailing Address - Country:US
Mailing Address - Phone:973-778-6676
Mailing Address - Fax:973-778-2666
Practice Address - Street 1:905 ALLWOOD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1933
Practice Address - Country:US
Practice Address - Phone:973-778-6676
Practice Address - Fax:973-778-2666
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00187600363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical