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 | | 117605 | 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 | 317651 | OTHER | NEW YORK | EMPIRE BC/BS &EMPIRE DIRE |
| 2 | 117605-A18 | OTHER | NEW YORK | HEALTHFIRST |
| 3 | B12840 | MEDICARE UPIN | NEW YORK | |
| 4 | 317651 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 5 | 450850 | OTHER | NEW MEXICO | US HEALTHCARE |
| 6 | 317651 | OTHER | NEW YORK | BLUE CHICE |
| 7 | 3319569 | OTHER | NEW YORK | CIGNA |
| 8 | 11-2574642 | OTHER | NEW YORK | EMPIRE PLAN MET LIFE |
| 9 | KS677(303342) | OTHER | NEW MEXICO | OXFORD |
| 10 | 1099388 | OTHER | NEW YORK | GHI |
| 11 | 165109 | OTHER | NEW YORK | ELDERPLAN |
| 12 | 11-2574642 | OTHER | NEW MEXICO | EMPIRE PLAN USHEALTHCARE |
| 13 | 00242686 | MEDICAID | NEW YORK | |
| 14 | 0353605-007 | OTHER | NEW YORK | CIGNA MEDICARE |
| 15 | 4366041 | OTHER | NEW MEXICO | AETNA |
| 16 | 117605 | OTHER | NEW YORK | HIP |
| 17 | 117605-A18 | OTHER | NEW YORK | MANAGED HEALTH INC |
