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 | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | | 134874 | NEW YORK | No |
| 2 | 208100000X | Physical Medicine & Rehabilitation | | 134874 | NEW YORK | No |
| 3 | 2083S0010X | Preventive Medicine | Sports Medicine | 134874 | NEW YORK | No |
| 4 | 208VP0000X | Pain Medicine | Pain Medicine | 134874 | NEW YORK | No |
| 5 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | 137874 | NEW YORK | No |
| 6 | 209800000X | Legal Medicine | | 134874 | NEW YORK | No |
| 7 | 207Q00000X | Family Medicine | | 134874 | 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 | 05A731 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | BC/BS MEDICARE # |
| 2 | 07052 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | GHI MEDICARE IDTF # |
| 3 | E78198 | MEDICARE UPIN | NEW YORK | |
| 4 | 05137 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | GHI MEDICARE # |
| 5 | 007 998 80 | MEDICAID | NEW YORK | |
| 6 | 07267 | MEDICARE PIN | NEW YORK | |
