Healthcare Provider Details

I. General information

NPI: 1780393017
Provider Name (Legal Business Name): MR. ALONE RENNORDO WHYTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 HUDSON ST FL 5
NEW YORK NY
10013-2993
US

IV. Provider business mailing address

100 ERDMAN PL APT 7A
BRONX NY
10475-5364
US

V. Phone/Fax

Practice location:
  • Phone: 347-431-5427
  • Fax:
Mailing address:
  • Phone: 347-431-5427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number000000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: