Individual provider Active NPI

Amy White, D.O.

  • Surgery Physician
  • Montclair, NJ
National Provider Identifier
1366821258
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
25MB11220900 Issued in NJ
Practice address
37 N Fullerton Ave
Montclair, NJ 07042-3426
Phone
(973) 509-1818
Fax
(973) 509-0532
NPI assigned
May 25, 2015
Last updated
Sep 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Surgery Physician 208600000X 25MB11220900 NJ Primary

Addresses

Primary practice location

37 N Fullerton Ave
Montclair, NJ 07042-3426

Mailing address

37 N Fullerton Ave
Montclair, NJ 07042-3426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210817003916 NJ Practitioner - General Surgery 2961807706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Montclair Breast Center PCGroup PAC ID 6608881602, 12 clinicians

Practice addresses (Care Compare)

37 N Fullerton Ave
2ND Floor
Montclair, NJ 07042-3446
Phone (973) 509-1818

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy18
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
25MB11220900NJMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Montclair Breast Center PC Surgery CurrentSince Sep 1, 2021 Accepting new patients

Locations

37 N Fullerton Ave
Ste 2
Montclair, NJ 07042
Phone (973) 509-1818

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1366821258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 N FULLERTON AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 N FULLERTON AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070423426",
            "telephone_number": "973-509-1818",
            "fax_number": "973-509-0532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "AMY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-25",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MB11220900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

Verify at the official NPI Registry.