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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 115302 | 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 | 5809328 | OTHER | NEW YORK | AETNA PROVIDER ID# |
| 2 | 115302-2 | OTHER | NEW YORK | WORKERS COMPENSATION |
| 3 | 2911 | OTHER | NEW YORK | EXCELLUS BSH PROV ID |
| 4 | 060056872 | OTHER | NEW YORK | RAILROAD MEDICARE PROV ID |
| 5 | BB7647 | MEDICARE UPIN | NEW YORK | |
| 6 | MDE486 | OTHER | NEW YORK | PREFERRED CARE PROV ID |
| 7 | BB7647 | MEDICARE ID-TYPE UNSPECIFIED | | PROVIDER ID # |
| 8 | 010115302 | OTHER | NEW YORK | BLUE CHOICE PROV ID |
| 9 | 00487105 | MEDICAID | NEW YORK | |
