Healthcare Provider Details

I. General information

NPI: 1326595547
Provider Name (Legal Business Name): W. MATTHEW WHITE, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800A 5TH AVE SUITE 202
NEW YORK NY
10065-7215
US

IV. Provider business mailing address

800A 5TH AVE SUITE 202
NEW YORK NY
10065-7215
US

V. Phone/Fax

Practice location:
  • Phone: 646-957-7207
  • Fax: 646-568-7171
Mailing address:
  • Phone: 646-957-7207
  • Fax: 646-568-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number24901
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM MATTHEW WHITE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 646-957-7207