Provider Demographics
NPI:1881634558
Name:WHITE, JOSH (DPM, PLLC)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPM, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2100
Mailing Address - Country:US
Mailing Address - Phone:973-313-0973
Mailing Address - Fax:
Practice Address - Street 1:1 WEST 85TH ST
Practice Address - Street 2:STE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-874-0564
Practice Address - Fax:208-247-3024
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY46951213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1246180001OtherDMEPOS
NY1246180001OtherDMEPOS