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 | 208800000X | Urology | | 124932 | 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 | CC6073 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 2 | 1900822 | OTHER | | IHA ENCOMPASS 65 |
| 3 | 0010640 | OTHER | | GHI |
| 4 | 000507827003 | OTHER | | COMMUNITY BLUE ADVANTAGE |
| 5 | 000507827003 | OTHER | | COMMUNITY BLUE |
| 6 | B36099 | MEDICARE UPIN | | |
| 7 | 00631434 | MEDICAID | NEW YORK | |
| 8 | 1900822 | OTHER | | INDEPENDENT HEALTH |
| 9 | 000507827003 | OTHER | | CB COMMUNITY CARE FAMILY |
| 10 | 00010140903 | OTHER | | BUFFALO COMMUNITY HEALTH |
| 11 | 1900822 | OTHER | | IHA MEDISOURCE |
| 12 | 00010140903 | OTHER | | UNIVERA CHOICE CARE |
| 13 | 000507827003 | OTHER | | COMMUNITY BLUE SENIOR BLU |
| 14 | AA0860 | MEDICARE ID-TYPE UNSPECIFIED | | GROUP |
| 15 | 00010140903 | OTHER | | UNIVERA |
| 16 | 00631434 | OTHER | | GOLD CHOICE MCD |
| 17 | 000507827003 | OTHER | | BLUE CROSS BLUE SHIELD WN |
| 18 | CC6073 | MEDICARE ID-TYPE UNSPECIFIED | | |
