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 | | 038571 | CONNECTICUT | No |
| 2 | 208000000X | Pediatrics | | 190123-1 | 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 | 000000045874 | OTHER | NEW YORK | GHI HMO |
| 2 | 133884168 | OTHER | NEW YORK | EMPIRE STATE PLAN (NYS) |
| 3 | 190123 | OTHER | NEW YORK | HIP |
| 4 | 509441 | OTHER | NEW YORK | PHCS |
| 5 | 5472713 | OTHER | NEW YORK | AETNA NON HMO |
| 6 | 2698775 | OTHER | NEW YORK | GHI PPO |
| 7 | 01943604046 | MEDICAID | NEW YORK | |
| 8 | 133884168 | OTHER | NEW YORK | BEECH STREET |
| 9 | 69H961 | OTHER | NEW YORK | BLUE CROSS ALL PLANS |
| 10 | 133884168 | OTHER | NEW YORK | POMCO |
| 11 | 190123 | OTHER | NEW YORK | CONNECTICARE |
| 12 | 370015781 | OTHER | NEW YORK | RAILROAD MEDICARE |
| 13 | 2135994 | OTHER | NEW YORK | AETNA HMO |
| 14 | 9180048-003 | OTHER | NEW YORK | CIGNA |
| 15 | 133884168 | OTHER | NEW YORK | MULTIPLAN |
| 16 | 1884811 | OTHER | NEW YORK | UNITED HEALTH CARE |
| 17 | P1111436 | OTHER | NEW YORK | OXFORD |
| 18 | OD1484 | OTHER | NEW YORK | HEALTH NET |
