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 | 2085R0001X | Radiology | Radiation Oncology | 183949 | NEW YORK | No |
| 2 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 183949 | NEW YORK | No |
| 3 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 25MA06934900 | NEW JERSEY | No |
| 4 | 2085R0001X | Radiology | Radiation Oncology | MD469511 | PENNSYLVANIA | 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 | 080506000082 | OTHER | NEW YORK | FIDELIS CARE |
| 2 | 2686E1 | OTHER | NEW YORK | EMPIRE BCBS (YONKERS) |
| 3 | 5551677 | OTHER | NEW YORK | AETNA PPO PROVIDER # |
| 4 | 321310 | OTHER | NEW YORK | US FAMILY HEALTH PLAN |
| 5 | 183949-NY | OTHER | NEW YORK | 1199 HEALTH FUND PROVIDER # |
| 6 | 01267918 | MEDICAID | NEW YORK | |
| 7 | 1000066816 | OTHER | NEW YORK | AFFINITY HEALTH PLANS |
| 8 | 10487600 | OTHER | | CAQH |
| 9 | 1768750 | OTHER | NEW YORK | AETNA HMO PROVIDER # |
