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 | 207R00000X | Internal Medicine | | 027982 | CONNECTICUT | No |
| 2 | 207R00000X | Internal Medicine | | 148605 | 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 | 1320459 | OTHER | NEW YORK | UNITED HEALTH CARE |
| 2 | 133884168 | OTHER | NEW YORK | EMPIRE STATE PLAN (NYS) |
| 3 | 0994674 | MEDICAID | NEW YORK | |
| 4 | 148605-9 | OTHER | NEW YORK | WORKERS COMPENSATION |
| 5 | 8279 | OTHER | NEW YORK | PHCS |
| 6 | 133884168 | OTHER | NEW YORK | MULTIPLAN |
| 7 | 86D691 | OTHER | NEW YORK | BLUE CROSS PPO |
| 8 | B19730 | MEDICARE UPIN | NEW YORK | |
| 9 | 0032002 | OTHER | NEW YORK | GHI PPO |
| 10 | 110142525 | OTHER | NEW YORK | RAILROAD MEDICARE |
| 11 | 133884168 | OTHER | NEW YORK | POMCO |
| 12 | 148605 | OTHER | NEW YORK | CONNECTICARE |
| 13 | 110007957/C03316 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
| 14 | 133884168 | OTHER | NEW YORK | BEECH STREET |
| 15 | 493761 | OTHER | NEW YORK | AETNA HMO |
| 16 | WP297 | OTHER | NEW YORK | OXFORD |
| 17 | 86D691 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 18 | 0307888-007 | OTHER | NEW YORK | CIGNA |
| 19 | 4360135 | OTHER | NEW YORK | AETNA NON HMO |
| 20 | ODO865/2C9222 | OTHER | NEW YORK | HEALTH NET |
