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 | 208100000X | Physical Medicine & Rehabilitation | | 202294 | NEW YORK | No |
| 2 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | 202294 | NEW YORK | Yes |
| 3 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | 202294 | 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 | 2124202 | OTHER | NEW YORK | AETNA HMO |
| 2 | 2700475 | OTHER | NEW YORK | GHI PPO |
| 3 | 1716J1 | OTHER | NEW YORK | EMPIRE BCBS (AIRMONT) |
| 4 | 392991 | OTHER | NEW YORK | MVP (MONROE) |
| 5 | 250010982 | OTHER | NEW YORK | RAILROAD MEDICARE |
| 6 | P402546 | OTHER | NEW YORK | OXFORD |
| 7 | 392989 | OTHER | NEW YORK | MVP (AIRMONT/STONY POINT) |
| 8 | 94E492 | OTHER | NEW YORK | EMPIRE BCBS (STONY POINT) |
| 9 | 01934683 | MEDICAID | NEW YORK | |
| 10 | 94E493 | OTHER | NEW YORK | EMPIRE BCBS (MONROE) |
| 11 | 132721370 | OTHER | NEW YORK | TAX ID# |
| 12 | 2700475 | OTHER | NEW YORK | HEALTHNET |
| 13 | 4299887 | OTHER | NEW YORK | AETNA PPO |