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 | 207R00000X | Internal Medicine | | 212634 | 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 | 212634 | OTHER | NEW YORK | HIP PROVIDER # |
| 2 | 5523805-008 | OTHER | NEW YORK | CIGNA PROVIDER # |
| 3 | 085AC1 | OTHER | NEW YORK | EMPIRE BC BS |
| 4 | E61397 | MEDICARE UPIN | | |
| 5 | 919055 | OTHER | NEW YORK | UNITED HEALTHCARE PROVIDE |
| 6 | 02355659 | MEDICAID | NEW YORK | |
| 7 | 4134064 | OTHER | NEW YORK | AETNA PROVIDER # |
| 8 | P2632416 | OTHER | NEW YORK | OXFORD PROVIDER # |
| 9 | 05577G | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | GHI MEDICARE |
| 10 | 2594554 | OTHER | NEW YORK | GHI PROVIDER # |
| 11 | 042AE1 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | EMPIRE MEDICARE |
