Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 155591 | NEW YORK | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 00931159 | MEDICAID | NEW YORK | |
| 2 | 41D361 | MEDICARE PIN | NEW YORK | |
| 3 | 0149041 | OTHER | NEW YORK | GHI PPO |
| 4 | 01HCQV | OTHER | NEW YORK | GHI/MEDICARE |
| 5 | 060012676 | OTHER | NEW YORK | RR MEDICARE ID # |
| 6 | NJ5591 | OTHER | NEW YORK | ATLANTIS HEALTH PLAN |
| 7 | CF7168 | OTHER | NEW YORK | RR MEDICARE GROUP # |
| 8 | 4238591 | OTHER | NEW YORK | AETNA PPO ID # |
| 9 | 132789080 | OTHER | NEW YORK | TAX IDENTIFICATION # |
| 10 | A62659 | MEDICARE UPIN | NEW YORK | |
| 11 | 41D361 | MEDICARE UPIN | NEW YORK | |
| 12 | 0858495 | OTHER | NEW YORK | AETNA HMO ID # |
| 13 | A400057743 | MEDICAID | NEW YORK | |
| 14 | DO0835 | OTHER | NEW YORK | OXFORD ID # |
| 15 | 41D363 | OTHER | NEW YORK | EMPIRE BCBS |
| 16 | G400000055 | MEDICARE PIN | NEW YORK | |
