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 | 207Q00000X | Family Medicine | | 139173 | 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 | 112665191 | OTHER | NEW YORK | PHCS |
| 2 | 1308 | OTHER | NEW YORK | VYTRA HEALTH PLANS |
| 3 | 35A411 | OTHER | NEW YORK | EMPIRE BLUECHOICE |
| 4 | CP127 | OTHER | NEW YORK | OXFORD HEALTH PLANS |
| 5 | AA50719 | OTHER | NEW YORK | MDNY HEALTHCARE |
| 6 | 5689628 | OTHER | NEW YORK | FIRST HEALTH-CCN NETWORK |
| 7 | 35A413 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 8 | 0569674 | OTHER | NEW YORK | CIGNA HEALTHCARE |
| 9 | 112665191 | OTHER | NEW YORK | MAGNACARE |
| 10 | 112665191 | OTHER | NEW YORK | GREAT-WEST HEALTHCARE |
| 11 | 000000093117 | OTHER | NEW YORK | GHI - HMO |
| 12 | 28063 | OTHER | NEW YORK | AETNA HMO PROVIDER NUMBER |
| 13 | B13561 | MEDICARE UPIN | NEW YORK | |
| 14 | 0H644P | OTHER | NEW YORK | HIP |
| 15 | 3C8937 | OTHER | NEW YORK | HEALTH NET |
| 16 | 43917375 | OTHER | NEW YORK | MULTIPLAN |
| 17 | 112665191 | OTHER | NEW YORK | THE EMPIRE PLAN (UHC) |
| 18 | 0057330 | OTHER | NEW YORK | GHI |
| 19 | 4061665 | OTHER | NEW YORK | AETNA PROVIDER NUMBER |
