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 | 207RA0000X | Internal Medicine | Adolescent Medicine | 223994 | NEW YORK | No |
| 2 | 207RS0010X | Internal Medicine | Sports Medicine | 223994 | NEW YORK | No |
| 3 | 208000000X | Pediatrics | | 223994 | NEW YORK | No |
| 4 | 2080A0000X | Pediatrics | Adolescent Medicine | 223994 | NEW YORK | No |
| 5 | 2080S0010X | Pediatrics | Sports Medicine | 223994 | NEW YORK | No |
| 6 | 207R00000X | Internal Medicine | | 223994 | 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 | 683AC1 | OTHER | NEW YORK | EMPIRE BLUE CROSS/SHEILD |
| 2 | P340056 | OTHER | NEW YORK | OXFORD |
| 3 | WZVQQ1 | MEDICARE PIN | NEW YORK | |
| 4 | 0174622 | OTHER | NEW YORK | GHI |
| 5 | 02769449 | OTHER | NEW YORK | MAGNACARE |
| 6 | ========= | OTHER | NEW YORK | 1199 NATIONAL BENEFIT FUND |
| 7 | 2239941 | OTHER | NEW YORK | HIP |
| 8 | 3705930 | OTHER | NEW YORK | AETNA HMO |
| 9 | 6C5961 | OTHER | NEW YORK | HEALTH NET |
| 10 | 000000119735 | OTHER | NEW YORK | GHI HMO |
| 11 | 0739492 | OTHER | NEW YORK | CIGNA |
| 12 | 219924601 | OTHER | NEW YORK | UNITED HEALTHCARE |
| 13 | 5333768 | OTHER | NEW YORK | AETNA PPO |
