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 | 225000000X | Orthotic Fitter | | CFO02565 | DELAWARE | No |
| 2 | 224L00000X | Pedorthist | | CPED1198 | DELAWARE | No |
| 3 | 225100000X | Physical Therapist | | 019369 | NEW YORK | No |
| 4 | 363A00000X | Physician Assistant | | 008387 | NEW YORK | No |
| 5 | 222Z00000X | Orthotist | | | 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 | 0000180974616 | OTHER | NEW YORK | OPTUM HEALTH PHYSICAL THERAPY-UNITED HEALTHCARE |
| 2 | 0401995 | OTHER | NEW YORK | AETNA- LOCAL 1199/ORTHONET |
| 3 | 272438120 | OTHER | NEW YORK | POMCO |
| 4 | 616130500 | OTHER | NEW YORK | FECA/ OFFICE OF FEDERAL WORKERS COMPENSATION |
| 5 | 272438120 | OTHER | NEW YORK | MAGNACARE |
| 6 | P4162456 | OTHER | NEW YORK | OPTUM HEALTH PHYSICAL THERAPY- OXFORD HEALTH PLAN-FREEDOM/LIBERTY |
| 7 | Q622E1 | OTHER | NEW YORK | EMPIRE BLUE CROSS |
| 8 | 11556837 | OTHER | | CAQH |
| 9 | 272438120 | OTHER | NEW YORK | MULTIPLAN-GEHA |
| 10 | 272438120 | OTHER | NEW YORK | AGEWELL HEALTH PLAN |
| 11 | 3017337 | OTHER | NEW YORK | MVP |
| 12 | 03021730 | MEDICAID | NEW YORK | |
| 13 | 272438120 | OTHER | NEW YORK | AMERIGROUP HEALTH PLAN |
| 14 | 272438120 | OTHER | NEW YORK | VNS CHOICE HEALTH PLAN |
| 15 | 0401995 | OTHER | NEW YORK | AETNA-ORTHONET |
| 16 | 272438120 | OTHER | NEW YORK | HUMANA HEALTH PLAN |
| 17 | 703204 | OTHER | NEW YORK | OPTUM HEALTH PHYSICAL THERAPY- EMPIRE STATE AND ORANGE COUNTY |
| 18 | 0401995 | OTHER | NEW YORK | CIGNA HEALTHCARE-ORTHONET |
| 19 | 272438120 | OTHER | NEW YORK | MULTI-PLAN |
| 20 | 272438120 | OTHER | NEW YORK | AFFINITY HEALTH PLAN |
| 21 | 272438120 | OTHER | NEW YORK | HUDSON HEALTH PLAN |
