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 | 174400000X | Specialist | | | 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 | 263784 | OTHER | NEW YORK | HEALTHNET |
| 2 | 329 | OTHER | NEW YORK | MONTE |
| 3 | H6549 | OTHER | NEW YORK | HOMELINK |
| 4 | G70211 | OTHER | NEW YORK | EMPIRE BLUE CROSS SHIELD |
| 5 | 131708249-001 | OTHER | NEW YORK | HEALTH FIRST |
| 6 | 01055150 | MEDICAID | NEW YORK | |
| 7 | ANC 1649 | OTHER | NEW YORK | OXFORD |
| 8 | 47173000 | OTHER | NEW YORK | BRONX HEALTH PLAN |
| 9 | 040401001680 | OTHER | NEW YORK | CENTER CARE |
| 10 | 557052 | OTHER | NEW YORK | AETNA |
| 11 | 0267660001 | MEDICARE NSC | NEW YORK | |
