Healthcare Provider Details

I. General information

NPI: 1689836074
Provider Name (Legal Business Name): BONNIE WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

761 MIDDLE COUNTRY RD
SELDEN NY
11784-2550
US

V. Phone/Fax

Practice location:
  • Phone: 516-631-4191
  • Fax:
Mailing address:
  • Phone: 631-736-4064
  • Fax: 631-736-1332

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 Code207L00000X
TaxonomyAnesthesiology Physician
License Number264922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: