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 | 213E00000X | Podiatrist | | 65 003356 | 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 | 000405895002 | OTHER | | BSNENY LEGACY NUMBER |
| 2 | Y023437 | OTHER | | TRICARE / CHAMPA/ CHAMPVA LEGACY NUMBER |
| 3 | 100179375401 | OTHER | | UNITED HEALTHCARE LEGACY NUMBER |
| 4 | 103301 | OTHER | | WELLCARE LEGACY NUMBER |
| 5 | 200053170 | OTHER | | MVP HEALTH PLAN GROUP IDENTIFIER |
| 6 | 33D0164140 | OTHER | | CLIA IDENTIFIER |
| 7 | 0488940001 | MEDICARE OSCAR/CERTIFICATION | | |
| 8 | 5934707 | OTHER | | AETNA, AETNA US HEALTHCARE LEGACY NUMBER |
| 9 | 257734 | OTHER | | UNITED HEALTHCARE GROUP LEGACY NUMBER |
| 10 | 4316059 | OTHER | | CARECORE AETNA HEALTH LEGACY NUMBER |
| 11 | 007552991 | MEDICAID | NEW YORK | |
| 12 | CJ2100 | OTHER | | RAIL ROAD MEDICARE GROUP PIN IDENTIFIER |
| 13 | 30061 | OTHER | | LAST 5 TIN |
| 14 | T51081 | MEDICARE UPIN | | |
| 15 | P3603PAE21 | MEDICARE PIN | | |
| 16 | 547001 | OTHER | | MVP HEALTHPLAN LEGACY NUMBER |
| 17 | 5102863 | OTHER | | CCN WORKERS COMP LEGACY NUMBER |
| 18 | 1793754 | OTHER | | NYS EMPIRE PLAN UNITED HEALTHCARE LEGACY NUMBER |
| 19 | 2C3717 | OTHER | | PHS LEGACY NUMBER |
| 20 | 408871001 | OTHER | | BSNENY GROUP LEGACY NUMBER |
| 21 | PAWE21 | MEDICARE PIN | | |
| 22 | 0073856 | OTHER | | GHI ,GHI HMO SELECT LEGACY NUMBER |
| 23 | DUS001 | OTHER | | OXFORD HEALTHCARE LEGACY NUMBER |
| 24 | 10021259 | OTHER | | CDPHP LEGACY NUMBER |
| 25 | 0488940001 | MEDICARE NSC | | |
| 26 | LG0P360320 | OTHER | | BLUE CROSS BLUE SHIELD LEGACY NUMBER |
| 27 | 109052400 | OTHER | | GOVERNMENT WORKERS COMP LEGACY NUMBER |
| 28 | 480003167 | MEDICARE PIN | | |
