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 | 111N00000X | Chiropractor | | 38MC00492000 | NEW JERSEY | No |
| 2 | 111N00000X | Chiropractor | | X006709 | 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 | C06709-1 | OTHER | NEW YORK | WORKER'S COMPENSATION |
| 2 | P40683821 | OTHER | NEW YORK | MULTIPLAN PROVIDER # |
| 3 | 13362703001 | OTHER | NEW YORK | HIP PROVIDER # |
| 4 | 2C2939 | OTHER | NEW YORK | SMART CHOICE PROVIDER # |
| 5 | 5218351 | OTHER | NEW YORK | CIGNA PPO PROVIDER # |
| 6 | X49031 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 7 | 893574 | OTHER | NEW YORK | AMERIHEALTH PROVIDER # |
| 8 | 4559473 | OTHER | NEW YORK | AETNA PROVIDER NUMBER |
| 9 | 5800677 | OTHER | NEW YORK | GHI PROVIDER NUMBER |
| 10 | 838370 | OTHER | NEW YORK | FIRST HEALTH PROVIDER # |
| 11 | P2800784 | OTHER | NEW YORK | OXFORD PROVIDER NUMBER |
| 12 | U29185 | MEDICARE UPIN | NEW YORK | |
