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 | 111N00000X | Chiropractor | | X4362 | 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 | 2457 | OTHER | NEW YORK | VYTRA ID # |
| 2 | 938180 | OTHER | NEW YORK | PHS ID # |
| 3 | P-60721490 | OTHER | NEW YORK | MULTIPLAN PROV ID # |
| 4 | 2004029 | OTHER | NEW YORK | AETNA PROV ID# |
| 5 | 34255 | OTHER | NEW YORK | HEALTHNET PROV ID # |
| 6 | 37296 | OTHER | NEW YORK | ICM PROVIDER ID# |
| 7 | 927432 | OTHER | NEW YORK | MPN PROV ID # |
| 8 | P412489 | OTHER | NEW YORK | OXFORD PROV ID # |
| 9 | X35271 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 10 | 107741300 | OTHER | NEW YORK | ACS/NYS DEPT OF LABOR |
| 11 | 4543081 | OTHER | NEW YORK | UNITED HEALTHCARE ID # |
| 12 | 0012094 | OTHER | NEW YORK | GHI PROV ID# |
| 13 | X9K15 | OTHER | NEW YORK | EMPIRE BC/BS |
| 14 | 37820P | OTHER | NEW YORK | HIP/PRISM # |
| 15 | 050004362NY01 | OTHER | NEW YORK | ANTHEM PROV ID# |
| 16 | 4543081 | OTHER | NEW YORK | ACN GROUP PROV ID # |
| 17 | AA46887 | OTHER | NEW YORK | MDNY PROV ID# |
| 18 | P00076567 | OTHER | NEW YORK | RAILROAD MEDICARE # |
| 19 | 04362-2 | OTHER | NEW YORK | WORKERS COMP BOARD # |
| 20 | T81261 | MEDICARE UPIN | NEW YORK | |
