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 | 152W00000X | Optometrist | | VUT0055931 | 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 | 1271335 | OTHER | NEW YORK | UNITED HEALTH CARE ID |
| 2 | 205296P | OTHER | NEW YORK | HIP ID NUMBER |
| 3 | C400C1 | OTHER | NEW YORK | BLUECROSS/BLUESHIELD ID |
| 4 | P2188657 | OTHER | NEW YORK | OXFORD PROVIDER NUMBER |
| 5 | A300001030 | MEDICARE PIN | NEW YORK | |
| 6 | 090005593NY01 | OTHER | NEW YORK | ANTHEM BC/BS ID # |
| 7 | 01931855 | MEDICAID | NEW YORK | |
| 8 | 203164481 | OTHER | NEW YORK | HORIZON BLUE CROSS ID |
| 9 | 141290 | OTHER | NEW YORK | EYE MED ID |
| 10 | 4C9313 | OTHER | NEW YORK | HEALTHNET PROVIDER ID |
| 11 | 203164481 | OTHER | NEW YORK | POMCO PROVIDER NUMBER |
| 12 | 6599202 | OTHER | NEW YORK | GHI PROVIDER ID |
| 13 | 7778334 | OTHER | NEW YORK | CIGNA PROVIDER ID |
| 14 | U55939 | MEDICARE UPIN | NEW YORK | |
| 15 | 203164481 | OTHER | NEW YORK | MULTI-PLAN PROVIDER ID |
