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 | 213EP1101X | Podiatrist | Primary Podiatric Medicine | N003037 | NEW YORK | No |
| 2 | 213ES0131X | Podiatrist | Foot Surgery | N003037 | NEW YORK | No |
| 3 | 213E00000X | Podiatrist | | NOO3037 | 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 | P34003SN | OTHER | NEW YORK | BLEU CROSS/BLEU SHIELD |
| 2 | P.3037-0 | OTHER | NEW YORK | WORKER-COMPENSATION |
| 3 | T311940 | MEDICARE UPIN | NEW YORK | |
| 4 | #05834 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE-QUEENS |
| 5 | #0276134 | OTHER | NEW YORK | CIGNA-MEDICARE |
| 6 | 396200P | OTHER | NEW YORK | HIP PROVIDER NUMBER |
| 7 | 0046447 | OTHER | NEW YORK | GHI PROVIDER NUMBER |
| 8 | P3003 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE PROVIDER NUMBER |
| 9 | SP13669 | OTHER | NEW YORK | CENTER CARE PROVIDER NUMB |
| 10 | 0029644 P-64 P110 | OTHER | NEW YORK | OXFORD PLANS |
| 11 | 115, 119, 65 | OTHER | NEW YORK | FIDELIS |
| 12 | MPI:28980 | OTHER | NEW YORK | UNITED HEALTH PLANS |
| 13 | 0047963 | MEDICAID | NEW YORK | |
