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 | 2080P0008X | Pediatrics | Neurodevelopmental Disabilities | 001613 | NEW YORK | No |
| 2 | 2084N0402X | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | MD471964 | PENNSYLVANIA | 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 | 0100559 | OTHER | NEW YORK | AMERICHOICE |
| 2 | 501Z91 | OTHER | NEW YORK | EMPIRE BCBS |
| 3 | 02350567 | MEDICAID | NEW YORK | |
| 4 | 7863378 | OTHER | NEW YORK | AETNA PPO |
| 5 | 2196604 04 | OTHER | NEW YORK | UNITED HEALTHCARE |
| 6 | 2603656 | OTHER | NEW YORK | GHI |
| 7 | 001613-A15 | OTHER | NEW YORK | HEALTH FIRST |
| 8 | 1000028191 | OTHER | NEW YORK | AFFINITY HEALTH |
| 9 | 2969639 | OTHER | NEW YORK | AETNA USHC HMO |
| 10 | 4C2294 | OTHER | NEW YORK | HEALTH NET |
| 11 | 127400101 | OTHER | NEW YORK | HEALTH PLUS |
| 12 | P2640917 | OTHER | NEW YORK | OXFORD HEALTH PLAN |
