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 | 208600000X | Surgery | | 116387 | 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 | 000000014863 | OTHER | NEW YORK | HIP |
| 2 | 001814 | OTHER | NEW YORK | CONNECTICARE THRU MFHA, IPA |
| 3 | 701744 | OTHER | NEW YORK | US FAMILY HEALTH PLAN |
| 4 | 000000014863 | OTHER | NEW YORK | GHI HMO |
| 5 | 187TM1 | OTHER | NEW YORK | EMPIRE BCBS |
| 6 | P01084439 | OTHER | NEW YORK | RAILROAD MEDICARE |
| 7 | DOC067154 | OTHER | NEW YORK | VNS CHOICE |
| 8 | 201235200020 | OTHER | NEW YORK | AFFINITY HEALTH PLAN |
| 9 | 116387 | OTHER | NEW YORK | 1199 NATIONAL BENEFIT FUND |
| 10 | P4570623 | OTHER | NEW YORK | OXFORD PLAN THRU UNITED HEALTHCARE |
| 11 | 00369599 | MEDICAID | NEW YORK | |
| 12 | A400073104 | MEDICARE PIN | NEW YORK | |
| 13 | 339951 | MEDICARE PIN | NEW YORK | |
| 14 | 0465157 | OTHER | NEW YORK | CIGNA |
| 15 | 116387-A85 | OTHER | NEW YORK | HEALTH FIRST |
| 16 | 120727000113 | OTHER | NEW YORK | FIDELIS CARE |
| 17 | PRIS# 2920539 | OTHER | NEW YORK | HIP |
| 18 | 2671201 | OTHER | NEW YORK | GHI PPO |
| 19 | PPO ID# 0085762 | OTHER | NEW YORK | HIP |
| 20 | B13341 | MEDICARE UPIN | NEW YORK | |
| 21 | 4096851 | OTHER | NEW YORK | AETNA |
