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 | 111NN0400X | Chiropractor | Neurology | X006335-1 | 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 | ========= | OTHER | NEW YORK | UNITED HEALTHCARE |
| 2 | 5G21 | OTHER | NEW YORK | EMPIRE BC BS |
| 3 | P2679219 | OTHER | NEW YORK | OXFORD |
| 4 | ========= | OTHER | NEW YORK | TRICARE FOR LIFE |
| 5 | 07214G | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 6 | 3031202 | OTHER | NEW YORK | AETNA |
| 7 | ========= | OTHER | NEW YORK | 1199 BENEFIT FUND |
| 8 | ========= | OTHER | NEW YORK | AARAP |
| 9 | ========= | OTHER | NEW YORK | HIP |
| 10 | 5898013 | OTHER | NEW YORK | GHI |
| 11 | 07214 | MEDICARE PIN | NEW YORK | |
| 12 | ========= | OTHER | NEW YORK | PRISM HEALTH NETWORKS |
| 13 | ========= | OTHER | NEW YORK | PROGRESSIVE GROUP INS. CO |
| 14 | ========= | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | EMPIRE |
| 15 | C006335-6 | OTHER | NEW YORK | WORKER COMP. |
| 16 | ========= | OTHER | NEW YORK | MUTIPLAN |
| 17 | 4165432 | OTHER | NEW YORK | CIGNA |
