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 | 208000000X | Pediatrics | | 183576 | 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 | 1205912 | OTHER | NEW YORK | IHA LEGACY# |
| 2 | 006957 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 3 | 000523215006 | OTHER | NEW YORK | HEALTH NOW BCBS LEGACY# |
| 4 | 159921DL | OTHER | NEW YORK | PREFERRED CARE LEGACY# |
| 5 | 8494418 | MEDICAID | NEW YORK | |
| 6 | 000000082563 | OTHER | NEW YORK | GHI HMO LEGACY# |
| 7 | F77869 | MEDICARE UPIN | | |
| 8 | 00010154302 | OTHER | NEW YORK | UNIVERA LEGACY# |
| 9 | 040426003018 | OTHER | NEW YORK | FIDELIS LEGACY# |
| 10 | 139305-7W | OTHER | NEW YORK | WORKERS COMP LEGACY# |
