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 | 2080A0000X | Pediatrics | Adolescent Medicine | 135840 | 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 | 1C4455 | OTHER | NEW YORK | HEALTHNET PROV ID |
| 2 | 00315586 | MEDICAID | NEW YORK | |
| 3 | P434947 | OTHER | NEW YORK | OXFORD HEALTH PLAN PROVID |
| 4 | 31036732 | OTHER | NEW YORK | LABCORP PROV ID |
| 5 | 04894 | OTHER | NEW YORK | QUEST LABS PROV ID |
| 6 | 135840A17 | OTHER | NEW YORK | HF 1199 HOME CARE PROV ID |
| 7 | 1831X01 | OTHER | NEW YORK | NYC DEPT OF HEALTH ID |
| 8 | 0085974 | OTHER | NEW YORK | GHI PROVIDER ID |
| 9 | 16A361 | OTHER | NEW YORK | EMPIRE BC&BS PROV ID |
| 10 | 135840N01 | OTHER | NEW YORK | HIP PROVIDER ID |
| 11 | 54460N | OTHER | | CIGNA PROV ID |
| 12 | 1073280001 &12-01215 | OTHER | NEW YORK | UNITED HEALTHCARE PROV ID |
| 13 | 135840 | OTHER | NEW YORK | MEDICAL LICENSE |
