Healthcare Provider Details

I. General information

NPI: 1578759239
Provider Name (Legal Business Name): RONALD A WHITE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 UNION ST
RIDGEWOOD NJ
07450-4478
US

IV. Provider business mailing address

216 ENGLE ST
ENGLEWOOD NJ
07631-2444
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-4466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMA048362
License Number StateNJ

VIII. Authorized Official

Name: DR. RONALD A WHITE
Title or Position: OWNER
Credential: MD
Phone: 972-758-3595