Provider Demographics
NPI:1720160971
Name:WHITE, BERNARD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:PAUL
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 WILLIAMSBRIDGE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6289
Mailing Address - Country:US
Mailing Address - Phone:646-533-5200
Mailing Address - Fax:646-809-8597
Practice Address - Street 1:1610 WILLIAMSBRIDGE RD APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-6289
Practice Address - Country:US
Practice Address - Phone:646-533-5200
Practice Address - Fax:646-809-8597
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141426208600000X, 2086S0102X
NY1595232086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01202079Medicaid
FLPENDINGOtherMEDICARE
FLPENDINGMedicaid