Provider Demographics
NPI:1992752604
Name:WHITE MOUNTAIN RADIOLOGY INC
Entity type:Organization
Organization Name:WHITE MOUNTAIN RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-796-6400
Mailing Address - Street 1:17-17 ROUTE 208
Mailing Address - Street 2:WHITE MOUNTAIN ROBERT GAREY CPA PC
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2820
Mailing Address - Country:US
Mailing Address - Phone:201-796-6400
Mailing Address - Fax:201-796-4110
Practice Address - Street 1:600 SAINT JOHNSBURY RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3442
Practice Address - Country:US
Practice Address - Phone:603-444-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11863261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212281Medicaid
B13171Medicare UPIN
RE7145Medicare ID - Type Unspecified