Provider Demographics
NPI:1902238611
Name:WHITE, GARTH ASTON
Entity Type:Individual
Prefix:MR
First Name:GARTH
Middle Name:ASTON
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SHORE BLVD
Mailing Address - Street 2:6K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4030
Mailing Address - Country:US
Mailing Address - Phone:718-934-6203
Mailing Address - Fax:
Practice Address - Street 1:40 SHORE BLVD
Practice Address - Street 2:6K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4030
Practice Address - Country:US
Practice Address - Phone:718-934-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560468941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist