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 | 207Y00000X | Otolaryngology | | 1386041 | 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 | LR074A4110 | OTHER | NEW YORK | BCBS 3877 |
| 2 | 0176650001 | OTHER | | DMERC HEALTH NOW |
| 3 | LR074A4110 | OTHER | NEW YORK | BCBS 5011 |
| 4 | 40003746 | OTHER | | MDCR RRRB RAILROAD |
| 5 | 581919 | OTHER | | UNIT740800 UNITED HEALTHC |
| 6 | LR074A4110 | OTHER | NEW YORK | BCBS 5059 |
| 7 | LR074A4110 | MEDICARE PIN | NEW YORK | |
| 8 | 74A411 | OTHER | | MDCR SECONDARY |
| 9 | LR074A4110 | OTHER | NEW YORK | BCBS 1407 |
| 10 | B19139 | MEDICARE UPIN | | |
| 11 | 581919 | OTHER | | UHC UNITED HEALTHCARE |
| 12 | 581919 | OTHER | | UNITE 1600 UNITED HEALTHC |
| 13 | 581919 | OTHER | | UNITE 30555 UNITED HEALTH |
| 14 | LR074A4110 | OTHER | NEW YORK | BCBS 5036 |
| 15 | LR074A4110 | OTHER | NEW YORK | BCBS 3876 |
| 16 | LR074A4110 | OTHER | NEW YORK | BCBS 5047 |
| 17 | LR074A4110 | OTHER | NEW YORK | BCBS 5012 |
| 18 | LR074A4110 | OTHER | NEW YORK | BCBS 5077 |
| 19 | LR074A4110 | OTHER | NEW YORK | BCBS 5040 |