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 | | 140466 | NEW YORK | No |
| 2 | 2086S0129X | Surgery | Vascular Surgery | 140466 | 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 | 112922165KU01 | OTHER | NEW YORK | CAREPLUS HEALTH PLAN |
| 2 | 26864P | OTHER | NEW YORK | HIP/HEALTHCARE PARTNERS |
| 3 | KS318 | OTHER | NEW YORK | OXFORD HEALTH PLANS |
| 4 | 4252465 | OTHER | NEW YORK | AETNA/USHC |
| 5 | 010140466NY01 | OTHER | NEW YORK | AMERIHEALTH/MSSNY |
| 6 | 01071654 | MEDICAID | NEW YORK | |
| 7 | 164701 | OTHER | NEW YORK | ELDERPLAN |
| 8 | 4C5510 | OTHER | NEW YORK | HEALTHNET |
| 9 | 11292216501 | OTHER | NEW YORK | TOUCHTONE HEALTH PARTNERS |
| 10 | 258980201 | OTHER | NEW YORK | HEALTH PLUS |
| 11 | 28A761 | OTHER | NEW YORK | EMPIRE BC/BS |
| 12 | 7420210-013 | OTHER | NEW YORK | CIGNA HEALTHCARE |
| 13 | 802022 | OTHER | NEW YORK | FIRST HEALTH NETW. |
| 14 | 020012418 | OTHER | NEW YORK | MEDICARE/RR |
| 15 | 11-2922165 | OTHER | NEW YORK | CONSUMER HEALTH NETW. |
| 16 | BKX0462-01 | OTHER | NEW YORK | AMERICHOICE HEALTH PLAN |
| 17 | 11-2922165 | OTHER | NEW YORK | CCN/HUMANA |
| 18 | 172964 | OTHER | NEW YORK | WELLCARE |
