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 | 152W00000X | Optometrist | | | | No |
| 2 | 207W00000X | Ophthalmology | | 191748 | 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 | 040426017816 | OTHER | NEW YORK | FIDELIS CARE NY |
| 2 | 331630102 | OTHER | NEW YORK | HEALH PLUS JACKSON HEIGHT |
| 3 | 433B72 | OTHER | NEW YORK | EMPIRE BCBS KEW GARDENS H |
| 4 | 1000039036 | OTHER | NEW YORK | AFFINITY |
| 5 | 184622P | OTHER | NEW YORK | HIP PRIS KGH |
| 6 | 01490862 | MEDICAID | NEW YORK | |
| 7 | 0400770 | OTHER | NEW YORK | GHI CBP |
| 8 | 168287 | OTHER | NEW YORK | ELDERPLAN |
| 9 | 433B71 | OTHER | NEW YORK | EMPIRE BCBS JACKSON HEIGH |
| 10 | 191748 | OTHER | NEW YORK | NYS LICENSE |
| 11 | 31590P | OTHER | NEW YORK | HIP PRIS JH |
| 12 | 660000 | OTHER | NEW YORK | HCPIPA |
| 13 | QN00100 | OTHER | NEW YORK | AMERICHOICE NY |
| 14 | 191748-B-27 | OTHER | NEW YORK | HEALTHFIRST JACKSON HEIGH |
| 15 | 191748-A27 | OTHER | NEW YORK | HEALTHFIRST KEW GARDENS H |
| 16 | 331630101 | OTHER | NEW YORK | HEALTH PLUS KEW GARDENS H |
| 17 | 1269964 | OTHER | NEW YORK | UNITEDHEALTHCARE |
| 18 | P379137 | OTHER | NEW YORK | OXFORD |
