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 | 2085R0202X | Radiology | Diagnostic Radiology | 2016371 | 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 | 000524095010 | OTHER | | BLUE SHIELD OF WESTERN NY |
| 2 | P00346427 | OTHER | | RAILROAD MEDICARE |
| 3 | CRDRA20163 | OTHER | NEW YORK | WORKERS COMPENSATION |
| 4 | 145802FF | OTHER | | PREFERRED CARE |
| 5 | DD4908 | MEDICARE PIN | NEW YORK | |
| 6 | 300114647 | OTHER | | RAILROAD MEDICARE |
| 7 | 000524095015 | OTHER | | BLUE SHIELD OF WESTERN NY |
| 8 | G23106 | MEDICARE UPIN | | |
| 9 | 01625034 | MEDICAID | NEW YORK | |
| 10 | 000524095014 | OTHER | | BLUE SHIELD OF WESTERN NY |
| 11 | RB1273 | MEDICARE PIN | NEW YORK | |
| 12 | 00025092006 | OTHER | | UNIVERA |
| 13 | P00003636 | OTHER | | RAILROAD MEDICARE |
| 14 | 1609896 | OTHER | | INDEPENDANT HEALTH |
| 15 | RB6947 | OTHER | | RAILROAD MEDICARE |
| 16 | CC3117 | MEDICARE PIN | NEW YORK | |
