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 | 213E00000X | Podiatrist | | 65 004988 | 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 | 505870 | OTHER | | AETNA US LEGACY NUMBER |
| 2 | CJ2100 | OTHER | | RAILROAD MEDICARE GROUP LEGACY NUMBER |
| 3 | 000405793008 | OTHER | | BSNENY LEGACY NUMBER |
| 4 | 1793752 | OTHER | | UNITED HEALTHCARE GROUP LEGACY NUMBER |
| 5 | 1793752 | OTHER | | NYS EMPIRE PLAN UNITED HEALTHCARE LEGACY NUMBER |
| 6 | P821809B | OTHER | | OXFORD HEALTHCARE LEGACY NUMBER |
| 7 | CB0P565510 | OTHER | | BLUE CROSS BLUE SHIELD LEGACY NUMBER |
| 8 | U33609 | MEDICARE UPIN | | |
| 9 | 0488940001 | MEDICARE NSC | | |
| 10 | PAWE21 | MEDICARE PIN | | |
| 11 | 10032229 | OTHER | | CDPHP LEGACY NUMBER |
| 12 | 1C8554 | OTHER | | PHS LEGACY NUMBER |
| 13 | 109052400 | OTHER | | GOVERNMENT WORKERS COMP |
| 14 | 200053170 | OTHER | | MVP HEALTH PLAN GROUP LEGACY NUMBER |
| 15 | 408871001 | OTHER | | BSNENY GROUP LEGACY NUMBER |
| 16 | 6200857 | OTHER | | GHI LEGACY NUMBER |
| 17 | P821809B | OTHER | | OXFORD HEALTH CARE LEGACY NUMBER |
| 18 | P82109 | OTHER | | SECURE HORIZONS LEGACY NUMBER |
| 19 | 100107789201 | OTHER | | UNITED HEALTHCARE LEGACY NUMBER |
| 20 | 1235164997 | OTHER | | GROUP PRACTICE NPI |
| 21 | 0488940001 | MEDICARE OSCAR/CERTIFICATION | | |
| 22 | P5655PAE21 | MEDICARE PIN | | |
| 23 | 139099 | OTHER | | WELLCARE LEGACY NUMBER |
| 24 | 01515315 | MEDICAID | NEW YORK | |
| 25 | 480017095 | MEDICARE PIN | | |
| 26 | 33D0164140 | OTHER | | CLIA IDENTIFIER |
| 27 | 30061 | OTHER | | LAST 5 TIN |
| 28 | 200053170 | OTHER | | MVP HEALTHCARE GROUP LEGACY NUMBER |
| 29 | 39099 | OTHER | | GHI HMO SELECT LEGACY NUMBER |
| 30 | 5934707 | OTHER | | AETNA LEGACY NUMBER |
| 31 | 953501 | OTHER | | MVP HEALTH PLAN LEGACY NUMBER |
