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 | 207X00000X | Orthopaedic Surgery | | 150904-1 | NEW YORK | No |
| 2 | 207XS0114X | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 150904-1 | NEW YORK | Yes |
| 3 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | 150904-1 | NEW YORK | No |
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 | 37909 | OTHER | | AETNA |
| 2 | DS462 | OTHER | | OXFORD |
| 3 | C66796 | MEDICARE UPIN | | |
| 4 | G400007161 | MEDICARE PIN | NEW YORK | |
| 5 | 068371 | OTHER | NEW YORK | BLUE CROSS |
| 6 | 0006240 | OTHER | NEW YORK | GHI |
| 7 | 01055398 | MEDICAID | NEW YORK | |
| 8 | G100007158 | MEDICARE PIN | NEW YORK | |
| 9 | 06240B | MEDICARE ID-TYPE UNSPECIFIED | | |
| 10 | A100017326 | MEDICARE PIN | NEW YORK | |
| 11 | A400017346 | MEDICARE PIN | NEW YORK | |
