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 | 213E00000X | Podiatrist | | N005506 | 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 | 02004713 | MEDICAID | NEW YORK | |
| 2 | 1793757 | OTHER | | NYS EMPIRE PLAN UHEALTH CARE LEGACY NUMBER |
| 3 | 10087065 | OTHER | | CDPHP LEGACY NUMBER |
| 4 | 200053170 | OTHER | | MVP HEALTH PLAN GROUP LEGACY NUMBER |
| 5 | 86149 | OTHER | | GHI HMO SELECT LEGACY NUMBER |
| 6 | 33D0164140 | OTHER | | CLIA IDENTIFIER |
| 7 | 000416689002 | OTHER | | BSNENY LEGACY NUMBER |
| 8 | 1831772 | OTHER | NEW YORK | CIGNA LEGACY NUMBER |
| 9 | 7065094 | OTHER | | AETNA HEALTHCARE LEGACY NUMBER |
| 10 | P3208416 | OTHER | | OXFORD HEALTHCARE LEGACY NUMBER |
| 11 | 109052400 | OTHER | | GOVERNMENT WORKERS COMP LEGACY NUMBER |
| 12 | 2702517 | OTHER | | EVERCARE LEGACY NUMBER |
| 13 | 1793757 | OTHER | | UNITED HEALTHCARE LEGACY NUMBER |
| 14 | 244466 | OTHER | | WELLCARE LEGACY NUMBER |
| 15 | 5C8019 | OTHER | | PHS LEGACY NUMBER |
| 16 | 0497739 | OTHER | | CIGNA LEGACY NUMBER |
| 17 | 1235164997 | OTHER | | GROUP PRACTICE NPI NUMBER |
| 18 | 394648 | OTHER | | MVP HEALTH PLAN LEGACY NUMBER |
| 19 | 6202446 | OTHER | | GHI LEGACY NUMBER |
| 20 | CJ2100 | OTHER | | RAILROAD MEDICARE GROUP LEGACY NUMBER |
| 21 | 30061 | OTHER | | LAST 5 TIN |
| 22 | 408871001 | OTHER | | BSNENY GROUP LEGACY NUMBER |
| 23 | FS0PH59410 | OTHER | | EMPIRE BLUE CROSS BLUE SHIELD LEGACY NUMBER |