Provider Demographics
NPI:1841210689
Name:WHITE MEDICAL, PC
Entity Type:Organization
Organization Name:WHITE MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-635-1210
Mailing Address - Street 1:11905 80TH RD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1105
Mailing Address - Country:US
Mailing Address - Phone:718-635-1210
Mailing Address - Fax:718-663-7134
Practice Address - Street 1:11905 80TH RD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1105
Practice Address - Country:US
Practice Address - Phone:718-635-1210
Practice Address - Fax:718-663-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163661208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07373AOtherMEDICARE ID
NYWAW281Medicare ID - Type UnspecifiedGROUP
NY07373AMedicare PIN
NY07373AOtherMEDICARE ID