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 | 207RN0300X | Internal Medicine | Nephrology | 042936 | CONNECTICUT | No |
| 2 | 207RN0300X | Internal Medicine | Nephrology | 455919-1 | 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 | G45385 | MEDICARE UPIN | NEW YORK | |
| 2 | 000000077243 | OTHER | NEW YORK | GHI HMO |
| 3 | 0005947624 | OTHER | NEW YORK | AETNA (NON HMO) |
| 4 | 21N501/W2L683 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 5 | 002989 | OTHER | NEW YORK | CONNECTICARE |
| 6 | 133884168 | OTHER | NEW YORK | BEECH STREET |
| 7 | 133884168 | OTHER | NEW YORK | CIGNA SPECIALTY |
| 8 | 133884168 | OTHER | NEW YORK | EMPIR STATE PLAN (NYS) |
| 9 | 133884168 | OTHER | NEW YORK | MULTIPLAN |
| 10 | P670485 | OTHER | NEW YORK | OXFORD |
| 11 | 173AU1/173AU2 | OTHER | NEW YORK | BLUE CROSS ALL PLANS |
| 12 | 133884168 | OTHER | NEW YORK | HORIZON HEALTHCARE OF NY |
| 13 | 133884168 | OTHER | NEW YORK | POMCO |
| 14 | 3399522 | OTHER | NEW YORK | GHI PPO |
| 15 | 3375645 | OTHER | NEW YORK | AENTAN HMO |
| 16 | 1829646 | OTHER | NEW YORK | UNITED HEALTH CARE |
| 17 | 01695629/0233897 | MEDICAID | NEW YORK | |
| 18 | 0D2976 | OTHER | NEW YORK | HEALTH NET |
| 19 | 133884168 | OTHER | NEW YORK | HIP |
| 20 | 133884168 | OTHER | NEW YORK | PHCS |