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 | 207RX0202X | Internal Medicine | Medical Oncology | 69562 | CONNECTICUT | No |
| 2 | 207RX0202X | Internal Medicine | Medical Oncology | 2822966 | NEW YORK | No |
| 3 | 207RX0202X | Internal Medicine | Medical Oncology | 25MA12290200 | NEW JERSEY | 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 | P01040768 | OTHER | NEW YORK | RR MEDICARE |
| 2 | 02822966 | MEDICAID | NEW YORK | |
| 3 | 10053770301 | OTHER | NEW YORK | UNITEDHEALTHCARE COMMUNITY PLAN |
| 4 | 120306000078 | OTHER | NEW YORK | FIDELIS |
| 5 | 7466892 | OTHER | NEW YORK | AETNA |
| 6 | P4501305 | OTHER | NEW YORK | OXFORD |
| 7 | 1003535P | OTHER | NEW YORK | HIP |
| 8 | WEZ3504051 | OTHER | NEW YORK | GHI |
| 9 | 24232801 | OTHER | NEW YORK | SUFFOLK HEALTH PLAN |
| 10 | 3079995 | OTHER | NEW YORK | CIGNA |
| 11 | 522CJ2 | OTHER | NEW YORK | BLUE SHIELD |
| 12 | 2417484 | OTHER | NEW YORK | GHI |
| 13 | 998725 | OTHER | NEW YORK | VYTRA |
