Provider Demographics
NPI:1740485887
Name:WHITE, KEVIN S (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:108 BILBY ROAD
Mailing Address - Street 2:STE 201
Mailing Address - City:HACKETTSTOW
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-684-3005
Mailing Address - Fax:908-684-3301
Practice Address - Street 1:108 BILBY ROAD
Practice Address - Street 2:STE 201
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-684-3005
Practice Address - Fax:908-684-3301
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2014-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08382200207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100250Medicare PIN