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 | 208000000X | Pediatrics | | 164113 | 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 | 2600579 | OTHER | NEW YORK | GHI PPO ID |
| 2 | OSA 29050 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 3 | 2787 | OTHER | NEW YORK | VYTRA ID |
| 4 | 5B780 | OTHER | NEW YORK | EMPIRE BC/BS |
| 5 | 877643 | OTHER | NEW YORK | AETNA HMO ID |
| 6 | 1807144003 | OTHER | NEW YORK | CIGNA ID |
| 7 | O85640 | OTHER | NEW YORK | UNITED HEALTH CARE |
| 8 | 000000059056 | OTHER | NEW YORK | GHI HMO ID |
| 9 | 4061141 | OTHER | NEW YORK | AETNA NON-HMO ID |
| 10 | OC9245 | OTHER | NEW YORK | PHS / HEALTH NET |
| 11 | 164113 | OTHER | NEW YORK | HIP |
| 12 | CP103 | OTHER | NEW YORK | OXFORD ID |
| 13 | A62110 | MEDICARE UPIN | NEW YORK | |
| 14 | 01082773 | MEDICAID | NEW YORK | |
