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 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | | No |
| 2 | 213E00000X | Podiatrist | | N005278-1 | 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 | P10831 | OTHER | NEW YORK | EMPIRE BLUE CROSS BLUE SH |
| 2 | 150605577 | OTHER | NEW YORK | AMERICAN PROGRESSIVE |
| 3 | 2C6599 | OTHER | NEW YORK | HEALTHNET |
| 4 | ========= | OTHER | NEW YORK | UNITED HEALTH CARE |
| 5 | ========= | OTHER | NEW YORK | TRICARE |
| 6 | P68362 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 7 | 01879643 | MEDICAID | NEW YORK | |
| 8 | PCWB51 | OTHER | NEW YORK | AARP |
| 9 | ========= | OTHER | NEW YORK | LOOMIS COMPANY |
| 10 | PCWB51 | OTHER | NEW YORK | FIRST UNITED AMERICAN LIF |
| 11 | ========= | OTHER | NEW YORK | OPERATING ENG. LOCAL 825 |
| 12 | NY9999 | OTHER | NEW YORK | MUTUAL OF OMAHA |
| 13 | P1034534 | OTHER | NEW YORK | OXFORD |
| 14 | 5897820001 | MEDICARE NSC | NEW YORK | |
| 15 | U62526 | MEDICARE UPIN | NEW YORK | |
| 16 | 10035850 | OTHER | NEW YORK | CDPHP |
| 17 | 989630 | OTHER | NEW YORK | MVP |
| 18 | ========= 006 | OTHER | NEW YORK | CIGNA |
| 19 | 9108 | OTHER | NEW YORK | GHI |
| 20 | VANESSA DARMOCHWAL | OTHER | NEW YORK | INDECS |
