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 | 111N00000X | Chiropractor | | CO9080-5B | NEW YORK | No |
| 2 | 111N00000X | Chiropractor | | MC00580900 | NEW JERSEY | 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 | 640635 | OTHER | NEW YORK | ACN NY NJ |
| 2 | X5X771 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 3 | NJ05809 | OTHER | NEW JERSEY | HEALTHNET LANDMARK NJ |
| 4 | 5898227 | OTHER | NEW YORK | GHI ALIGNIS |
| 5 | X5X771 | OTHER | NEW YORK | BCBS NY |
| 6 | 2395999000 | OTHER | NEW JERSEY | AMERIHEALTH KEYSTONE HMO |
| 7 | P2198428 | OTHER | NEW YORK | OXFORD TRIAD NYNJ |
| 8 | 089830TG | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | MEDICARE NJ |
| 9 | 2945983 | OTHER | NEW YORK | AETNA ACN NY NJ |
| 10 | 1030676 | OTHER | NEW YORK | CIGNA ASH NY NJ |
| 11 | NY0796 | OTHER | NEW YORK | HEALTHNET LANDMARK NY |
| 12 | V00226 | MEDICARE UPIN | NEW YORK | |
