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 | 101YP2500X | Counselor | Professional | | | No |
| 2 | 152WC0802X | Optometrist | Corneal and Contact Management | | | No |
| 3 | 152WP0200X | Optometrist | Pediatrics | | | No |
| 4 | 152WV0400X | Optometrist | Vision Therapy | | | No |
| 5 | 152WX0102X | Optometrist | Occupational Vision | | | No |
| 6 | 207Q00000X | Family Medicine | | | | No |
| 7 | 207R00000X | Internal Medicine | | | | No |
| 8 | 208000000X | Pediatrics | | | | No |
| 9 | 225400000X | Rehabilitation Practitioner | | | | No |
| 10 | 2255R0406X | Specialist/Technologist | Rehabilitation, Blind | | | No |
| 11 | 225CA2400X | Rehabilitation Counselor | Assistive Technology Practitioner | | | No |
| 12 | 225CX0006X | Rehabilitation Counselor | Orientation and Mobility Training Provider | | | No |
| 13 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 14 | 246QM0706X | Specialist/Technologist, Pathology | Medical Technologist | | | No |
| 15 | 152WL0500X | Optometrist | Low Vision Rehabilitation | | | 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 | 02079638 | MEDICAID | NEW YORK | |
| 2 | 45-5060871 | OTHER | NEW YORK | SPEECH PATHOLOGIST |
| 3 | 35-2520568 | OTHER | NEW YORK | OCCUPATIONAL THERAPIST |
