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 | 207RC0200X | Internal Medicine | Critical Care Medicine | 235602 | NEW YORK | No |
| 2 | 207RP1001X | Internal Medicine | Pulmonary Disease | 235602 | 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 | 223227P | OTHER | NEW YORK | HIP ID # |
| 2 | P00260961 | OTHER | NEW YORK | RAILROAD MEDICARE |
| 3 | AA73450 | OTHER | NEW YORK | MDNY ID # |
| 4 | 235602OW | OTHER | NEW YORK | WORKER'S COMP ID # |
| 5 | WCW281 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE GROUP # |
| 6 | 8VO44 | OTHER | NEW YORK | BCBS GROUP # |
| 7 | 299268 | OTHER | NEW YORK | GHI ID # |
| 8 | ========= | OTHER | NEW YORK | TAX ID # |
| 9 | 1861894 | OTHER | NEW YORK | CIGNA ID # |
| 10 | 2144859 | OTHER | NEW YORK | VYTRA ID # |
| 11 | 2744154 | MEDICAID | NEW YORK | |
