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 | 207W00000X | Ophthalmology | | MA72439 | NEW JERSEY | No |
| 2 | 207W00000X | Ophthalmology | | 200777 | 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 | 2098181 | OTHER | | UNITED HEALTHCARE |
| 2 | 3015776 | OTHER | | CIGNA |
| 3 | 7932254 | OTHER | | AETNA US HEALTHCARE |
| 4 | 010200777NY01 | OTHER | | HORIZON HEALTHCARE OF NY |
| 5 | 0401949 | OTHER | | GHI |
| 6 | 200777A40 | OTHER | | HEALTHFIRST |
| 7 | 134177311 | OTHER | | LOCAL 1199 |
| 8 | 3C1014 | OTHER | | HEALTHNET PHS |
| 9 | KJ0777 | OTHER | | ATLANTIS |
| 10 | H18434 | MEDICARE UPIN | | |
| 11 | 384A51 | MEDICARE PIN | NEW YORK | |
| 12 | 134177311 | OTHER | | EMPIRE PLAN OF NY |
| 13 | 134177311 | OTHER | | PHCS GUARDIAN |
| 14 | P2498191 | OTHER | | OXFORD |
| 15 | 136805CR | OTHER | | PREFERRED CARE PREFERRED |
| 16 | 384A52 | OTHER | | EMPIRE BLUE CROSS BLUE SH |
| 17 | 02151797 | MEDICAID | NEW YORK | |
| 18 | 134177311 | OTHER | | MULTIPLAN |
