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 | 2084P0800X | Psychiatry & Neurology | Psychiatry | 141679 | NEW YORK | No |
| 2 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | 141679 | NEW YORK | No |
| 3 | 2084P0805X | Psychiatry & Neurology | Geriatric Psychiatry | 141679 | NEW YORK | No |
| 4 | 2084S0012X | Psychiatry & Neurology | Sleep Medicine | 141679 | 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 | 16965 | OTHER | NEW YORK | CIGNA ELECTRONIC ID# |
| 2 | 0075951 | OTHER | NEW YORK | GHI NY |
| 3 | 268593 | OTHER | NEW YORK | COMPSYCH |
| 4 | P62268927 | OTHER | NEW YORK | MULTIPLAN |
| 5 | 73A221 | OTHER | NEW YORK | BC BS EMPIRE NY |
| 6 | 68017 | OTHER | NEW YORK | VYTRA |
| 7 | P1075970 | OTHER | NEW YORK | OXFORD |
| 8 | 4551900 | OTHER | NEW YORK | MAGELLAN |
| 9 | 4209139 | OTHER | NEW YORK | AETNA ID# |
| 10 | PP47146 | OTHER | NEW YORK | MDNY |
| 11 | 071494 | OTHER | NEW YORK | VALUE OPTIONS |
| 12 | 141679N01 | OTHER | NEW YORK | HIP NY |
