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 | 174400000X | Specialist | | 135328 | NEW YORK | No |
| 2 | 2084N0400X | Psychiatry & Neurology | Neurology | 135328-1 | 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 | 112434927 | OTHER | NEW YORK | PHCS |
| 2 | 22A431 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE PROVIDER NUMBER |
| 3 | 0629923003 | OTHER | NEW YORK | CIGNA HEALTHCARE |
| 4 | 112434927 | OTHER | NEW YORK | TPA/ BENESIGHT |
| 5 | 112434927 | OTHER | NEW YORK | BEECH STREET CORPORATION |
| 6 | 22A431 | MEDICARE OSCAR/CERTIFICATION | | |
| 7 | OC2812 | OTHER | NEW YORK | PHS/ACS |
| 8 | 112434927 | OTHER | NEW MEXICO | FIRST HEALTH |
| 9 | 4394236 | OTHER | NEW YORK | AETNA MC/PPO/EPO |
| 10 | 112434927 | OTHER | NEW YORK | MULTIPLAN |
| 11 | 112434927 | OTHER | NEW YORK | ONE HEALTH PLAN |
| 12 | 112434927 | OTHER | NEW YORK | SELECT PRO |
| 13 | 22A431 | OTHER | NEW YORK | EMPIRE HEALTHCHOICE |
| 14 | 112434927 | OTHER | NEW YORK | ANTHEM HEALTH NETWORK |
| 15 | 112434927 | OTHER | NEW YORK | HORIZON HEALTHCARE |
| 16 | 112434927 | OTHER | NEW YORK | AMERIHEALTH |
| 17 | AS1212 | OTHER | NEW YORK | OXFORD HEALTH PLAN |
| 18 | C06877 | MEDICARE UPIN | | |
| 19 | 173485 | OTHER | NEW YORK | EMPIRE PLAN/UNITED HEALTH |
| 20 | 887954 | OTHER | NEW YORK | AETNA HMO |
| 21 | C06877 | MEDICARE UPIN | NEW YORK | |
