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 | 207L00000X | Anesthesiology | | 201339 | NEW YORK | No |
| 2 | 207LC0200X | Anesthesiology | Critical Care Medicine | 201339 | 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 | 01827045 | MEDICAID | NEW YORK | |
| 2 | 5172719 | OTHER | NEW YORK | AETNA PROVIDER# |
| 3 | 00040676701 | OTHER | | UNIVERA PROVIDER# |
| 4 | G0189393590 | OTHER | NEW YORK | BLUE CHOICE GROUP# |
| 5 | P710201339 | OTHER | | BLUE CHOICE ICU# |
| 6 | 2222 | OTHER | NEW YORK | BLUE SHIELD GROUP# |
| 7 | 000912153001 | OTHER | | BS WNY/HEALTHNOW# |
| 8 | MDC677 | OTHER | NEW YORK | PREFERRED CARE ANES# |
| 9 | P010201339 | OTHER | NEW YORK | BLUE CHOICE PROVIDER# |
| 10 | 00372225 | MEDICAID | NEW YORK | |
| 11 | MDG047 | OTHER | NEW YORK | PREFERRED CARE ICU# |
