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 | 174400000X | Specialist | | 106804 | NEW YORK | No |
| 2 | 2084N0400X | Psychiatry & Neurology | Neurology | 106804-1 | 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 | 1196482002 | OTHER | NEW YORK | CIGNA HEALTHCARE |
| 2 | 173486 | OTHER | NEW YORK | EMPIRE PLAN/UNITED HEALTH |
| 3 | 883074 | OTHER | NEW YORK | AETNA HMO |
| 4 | 112434927 | OTHER | NEW YORK | ANTHEM HEALTH NETWORK |
| 5 | 112434927 | OTHER | NEW YORK | SELECT PRO |
| 6 | 112434927 | OTHER | NEW YORK | BEECH STREET CORPORATION |
| 7 | 112434927 | OTHER | NEW YORK | TPA/ BENESIGHT |
| 8 | 957631 | OTHER | NEW YORK | EMPIRE HEALTH CHOICE |
| 9 | B79987 | MEDICARE UPIN | NEW YORK | |
| 10 | AS1203 | OTHER | NEW YORK | OXFORD |
| 11 | 112434927 | OTHER | NEW YORK | MULTIPLAN |
| 12 | 112434927 | OTHER | NEW YORK | FIRST HEALTH |
| 13 | 112434927 | OTHER | NEW YORK | PHCS |
| 14 | 112434927 | OTHER | NEW YORK | HORIZON HEALTHCARE |
| 15 | 4292117 | OTHER | NEW YORK | AETNA MC/PPO/EPO |
| 16 | 957631 | MEDICARE OSCAR/CERTIFICATION | | |
| 17 | 112434927 | OTHER | NEW YORK | AMERIHEALTH PPO/HMO/POS |
| 18 | OC2811 | OTHER | NEW YORK | PHS/ACS |
| 19 | 112434927 | OTHER | NEW YORK | ONE HEALTH PLAN |
