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 | | 201243 | 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 | 215251794 | OTHER | NEW YORK | HORIZON HMO PPO EPO |
| 2 | 80658 | OTHER | NEW YORK | VYTRA |
| 3 | G50425 | MEDICARE UPIN | NEW YORK | |
| 4 | WTW221 | MEDICARE PIN | NEW YORK | |
| 5 | 215251794 | OTHER | NEW YORK | MAGNACARE |
| 6 | 1321569 | OTHER | NEW YORK | FIRST HEALTH |
| 7 | 215251794 | OTHER | NEW YORK | BEECH STRET PPO EPO |
| 8 | 6015049 | OTHER | NEW YORK | GHI |
| 9 | 01754416 | MEDICAID | NEW YORK | |
| 10 | 010201243NY01 | OTHER | NEW YORK | ANTHEM |
| 11 | P688442 | OTHER | NEW YORK | OXFORD |
| 12 | 215251794 | OTHER | NEW YORK | PHCS |
| 13 | NS0002629 | OTHER | NEW YORK | SELECTPRO |
| 14 | 4C0504 | OTHER | NEW YORK | HEALTHNET |
| 15 | 0975075 | OTHER | NEW YORK | AETNA HMO POS |
| 16 | 97E241 | OTHER | NEW YORK | EMPIRE HEALTHCHOICE |
| 17 | 201243-A32 | OTHER | NEW YORK | HEALTHFIRST |
| 18 | 215251794 | OTHER | | CIGNA HMO POS |
| 19 | 3257243001 | OTHER | NEW YORK | CIGNA PPO EPO |
| 20 | 1469683 | OTHER | NEW YORK | UNITED HEALTHCARE |
