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 | 2080P0008X | Pediatrics | Neurodevelopmental Disabilities | 151333 | 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 | 9E2931 | OTHER | NEW YORK | EMPIRE BCBS |
| 2 | 2661329 | OTHER | NEW YORK | AETNA USHC HMO |
| 3 | PS1333 | OTHER | NEW YORK | ATLANTIS HEALTH |
| 4 | 12D371 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 5 | 151333 | OTHER | NEW YORK | HEALTH FIRST |
| 6 | 4C0890 | OTHER | NEW YORK | HEALTH NET |
| 7 | 1000004624 | OTHER | NEW YORK | AFFINITY HEALTH |
| 8 | 108053 15 | OTHER | NEW YORK | UNITED HEALTH CARE |
| 9 | 0066775 | OTHER | NEW YORK | GHI |
| 10 | 4312673 | OTHER | NEW YORK | AETNA PPO |
| 11 | P2532131 | OTHER | NEW YORK | OXFORD HEALTH PLAN |
| 12 | B01482 | MEDICARE UPIN | NEW YORK | |
| 13 | 00872371 | MEDICAID | NEW YORK | |
