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 | 207X00000X | Orthopaedic Surgery | | 194702-1 | 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 | 2872 | OTHER | NEW YORK | BC/BS ROCHESTER |
| 2 | 00040271503 | OTHER | NEW YORK | UNIVERA |
| 3 | 6076637 00 | OTHER | NEW YORK | BLACK LUNG |
| 4 | F73297 | MEDICARE UPIN | NEW YORK | |
| 5 | P010194702 | OTHER | NEW YORK | BLUE CHOICE |
| 6 | 689F71 | OTHER | NEW YORK | EMPIRE BC/BS |
| 7 | 000523180002 | OTHER | NEW YORK | BC/BS WNY |
| 8 | 611317900 | OTHER | | FEDERAL WORKERS COMP FECA |
| 9 | 000003862 | OTHER | NEW YORK | BLUESHIELD SYRACUSE |
| 10 | 000523180002 | OTHER | NEW YORK | COMMUNITY BLUE |
| 11 | 101501CU | OTHER | NEW YORK | PREFERRED CARE |
| 12 | RA1291 | MEDICARE PIN | | |
| 13 | 9744149 | OTHER | NEW YORK | GHI |
| 14 | 000523180002 | OTHER | NEW YORK | HEALTH NOW NY |
| 15 | P00308708 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | RAILROAD MEDICARE |
| 16 | 194702-COS1 | OTHER | NEW YORK | WORKERS COMP |
| 17 | 01559113 | MEDICAID | NEW YORK | |
