Healthcare Provider Details

I. General information

NPI: 1114149606
Provider Name (Legal Business Name): JUDITH WHITE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80TH STREET & 41ST AVENUE
ELMHURST NY
11373
US

IV. Provider business mailing address

7901 BROADWAY MANAGED CARE D-1-4
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-5970
  • Fax: 718-334-5958
Mailing address:
  • Phone: 718-334-1920
  • Fax: 718-334-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303373
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: