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 | 208600000X | Surgery | | 038407 | CONNECTICUT | No |
| 2 | 208600000X | Surgery | | 124616-1 | 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 | 129629 | OTHER | NEBRASKA | UNITED HEALTH CARE |
| 2 | 133884168 | OTHER | NEW YORK | BEECH STREET |
| 3 | 133884168 | OTHER | NEW YORK | 133884168 |
| 4 | 133884168 | OTHER | NEW YORK | HORIZON HEALTHCARE OF NY |
| 5 | 133884168 | OTHER | NEW YORK | POMCO |
| 6 | 2151396 | OTHER | NEW YORK | AETNA HMO |
| 7 | 8381598-002 | OTHER | NEW YORK | CIGNA |
| 8 | 000000045876 | OTHER | NEW YORK | GHI HMO |
| 9 | 14616-4W | OTHER | NEW YORK | WORKERS COMPENSATION |
| 10 | 18G751 | OTHER | NEW YORK | BLUE CROSS PPO |
| 11 | 4648927 | OTHER | NEW YORK | AETNA (NON HMO) |
| 12 | 124616 | OTHER | NEW YORK | CONNECTICARE |
| 13 | 124616-1 | OTHER | NEW YORK | HIP |
| 14 | 4C1385 | OTHER | NEW YORK | HEALTH NET |
| 15 | 01120754 | MEDICAID | NEW YORK | |
| 16 | 0199287 | OTHER | NEW YORK | GHI PPO |
| 17 | 133884168 | OTHER | NEW YORK | MULTIPLAN |
| 18 | P1104183 | OTHER | NEW YORK | OXFORD |
| 19 | F20863 | MEDICARE UPIN | | |
| 20 | 18G751 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
