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 | | 193792-1 | 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 | 5C5081 | OTHER | NEW YORK | HEALTHNET |
| 2 | 0007660031 | OTHER | NEW YORK | AETNA PPO |
| 3 | 002036444 | OTHER | NEW YORK | EMPIRE PLAN |
| 4 | P00306577 | MEDICARE PIN | NEW YORK | |
| 5 | 487A61 | OTHER | NEW YORK | EMPIRE BCBS |
| 6 | 41Z331 | MEDICARE PIN | NEW YORK | |
| 7 | P1882705 | OTHER | NEW YORK | OXFORD HEALTH PLAN |
| 8 | 0498239 | OTHER | NEW YORK | GHI PPO |
| 9 | G97816 | MEDICARE UPIN | NEW YORK | |
| 10 | 01984601 | MEDICAID | NEW YORK | |
| 11 | 010193792NY01 | OTHER | NEW YORK | ANTHEM BCBS |
| 12 | 925210 | OTHER | NEW YORK | BLOCKVISION |
| 13 | 1000049658 | OTHER | NEW YORK | AFFINITY |
| 14 | 10830 | OTHER | NEW YORK | HUDSON HEALTH PLAN |
| 15 | 3707272 | OTHER | NEW YORK | AETNA HMO |
| 16 | 84723 | OTHER | NEW YORK | GHI HMO |
| 17 | 032346 | OTHER | NEW YORK | COMMUNITY CHOICE HEALTH |
| 18 | 10049874 | OTHER | NEW YORK | CDPHP |
| 19 | 202345P | OTHER | NEW YORK | HIP |
