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 | 204D00000X | Neuromusculoskeletal Medicine & OMM | | 206159 | NEW YORK | No |
| 2 | 2084B0040X | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | 206159 | NEW YORK | No |
| 3 | 2084N0008X | Psychiatry & Neurology | Neuromuscular Medicine | 206159 | NEW YORK | No |
| 4 | 204R00000X | Electrodiagnostic Medicine | | 206159 | NEW YORK | No |
| 5 | 2084A0401X | Psychiatry & Neurology | Addiction Medicine | 206159 | NEW YORK | No |
| 6 | 2084A2900X | Psychiatry & Neurology | Neurocritical Care | 206159 | NEW YORK | No |
| 7 | 2084S0012X | Psychiatry & Neurology | Sleep Medicine | 206159 | NEW YORK | No |
| 8 | 2084V0102X | Psychiatry & Neurology | Vascular Neurology | 206159 | NEW YORK | No |
| 9 | 2084N0400X | Psychiatry & Neurology | Neurology | 206159 | NEW YORK | Yes |
| 10 | 2084P0005X | Psychiatry & Neurology | Neurodevelopmental Disabilities | 206159 | NEW YORK | No |
| 11 | 2084P0015X | Psychiatry & Neurology | Psychosomatic Medicine | 206159 | NEW YORK | No |
| 12 | 2084N0600X | Psychiatry & Neurology | Clinical Neurophysiology | 206159 | NEW YORK | No |
| 13 | 2084P0301X | Psychiatry & Neurology | Brain Injury Medicine | 206159 | NEW YORK | No |
| 14 | 2084S0010X | Psychiatry & Neurology | Sports Medicine | 206159 | NEW YORK | No |
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 | 01906770 | MEDICAID | NEW YORK | |
| 2 | 130020669 | OTHER | NEW YORK | RAILROAD MEDICARE |
| 3 | P919453 | OTHER | | OXFORD |
| 4 | 7676026 | OTHER | NEW YORK | AETNA |