Healthcare Provider Details

I. General information

NPI: 1366821258
Provider Name (Legal Business Name): AMY WHITE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 N FULLERTON AVE
MONTCLAIR NJ
07042-3426
US

IV. Provider business mailing address

37 N FULLERTON AVE
MONTCLAIR NJ
07042-3426
US

V. Phone/Fax

Practice location:
  • Phone: 973-509-1818
  • Fax: 973-509-0532
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MB11220900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: