Healthcare Provider Details

I. General information

NPI: 1962933820
Provider Name (Legal Business Name): TIMOTHY GERALD WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIMOTHY G WHITE MD

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR DEPARTMENT OF NEUROSURGERY, 9 TOWER
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

300 COMMUNITY DR DEPARTMENT OF NEUROSURGERY, 9 TOWER
MANHASSET NY
11030-3816
US

V. Phone/Fax

Practice location:
  • Phone: 631-561-9803
  • Fax:
Mailing address:
  • Phone: 631-561-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number329882
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: