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 | | | 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 | 4C8838 | OTHER | NEW YORK | HEALTHNET |
| 2 | 959 | OTHER | NEW YORK | CARECORE NATIONAL |
| 3 | S23958 | OTHER | NEW YORK | AMERICAN IMAGING MGNT |
| 4 | W1L822 | MEDICARE PIN | NEW YORK | |
| 5 | C51294 | OTHER | NEW YORK | AMERIHEALTH |
| 6 | A3184823 | OTHER | NEW YORK | OXFORD HEALTH PLAN |
| 7 | CD5054 | OTHER | NEW YORK | PALMETTO GBA |
| 8 | NY419 | OTHER | NEW YORK | ONE CALL MEDICAL |
| 9 | W1L822 | OTHER | NEW YORK | EMPIRE BLUE CROSS BLUE SH |
| 10 | 5516341 | OTHER | NEW YORK | FIRSTHEALTH |
| 11 | =========-057 | OTHER | NEW YORK | HEALTHFIRST |
| 12 | 1425155 | OTHER | NEW YORK | UNITED HEALTHCARE |
| 13 | 189300 | OTHER | NEW YORK | WELLCARE |
| 14 | 4199993 | OTHER | NEW YORK | GHI |
| 15 | 5481603 | OTHER | NEW YORK | AETNA US HEALTHCARE |
| 16 | 03235201 | MEDICAID | NEW YORK | |
