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 | 207NS0135X | Dermatology | Procedural Dermatology | 150992 | 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 | 07107 | OTHER | NEW YORK | MVP HEALTH PLAN PROVIDER |
| 2 | D02269 | MEDICARE UPIN | NEW YORK | |
| 3 | 10001906 | OTHER | NEW YORK | CDPHP PROVIDER NO. |
| 4 | 78E53 | OTHER | NEW YORK | EMP BC NUMBER |
| 5 | 070001277 | OTHER | NEW YORK | RR MEDICARE NO. |
| 6 | 39903B | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE PROVIDER NUMBER |
| 7 | 141667244 | OTHER | NEW YORK | TAX ID NO. |
