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 | 174400000X | Specialist | | 215965-1 | NEW YORK | No |
| 2 | 207W00000X | Ophthalmology | | 215965-1 | 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 | 10059047 | OTHER | NEW YORK | CDPHP ID # |
| 2 | 41206000018 | OTHER | NEW YORK | FIDELIS ID # |
| 3 | P3302156 | OTHER | NEW YORK | OXFORD ID # |
| 4 | U70433 | OTHER | NEW YORK | AMERIHEALTH ADMINISTRATOR |
| 5 | 000000056446 | OTHER | NEW YORK | GHI MEDICAID ID # |
| 6 | 455A61 | OTHER | NEW YORK | EMPIRE BCBS OF NY ID # |
| 7 | 215965 | OTHER | NEW YORK | HIP ID # |
| 8 | 3471925 | OTHER | NEW YORK | AETNA HMO ID # |
| 9 | 0498447 | OTHER | NEW YORK | GHI PPO ID # |
| 10 | 3C6549 | OTHER | NEW YORK | HEALTHNET ID # |
| 11 | H20323 | OTHER | NEW YORK | UPIN # |
| 12 | 02215396 | MEDICAID | NEW YORK | |
| 13 | 7733286 | OTHER | NEW YORK | AETNA PPO ID # |
