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 | 207ND0101X | Dermatology | MOHS-Micrographic Surgery | 216306 | 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 | 0102163306NY02 | OTHER | NEW YORK | ANTHEM PROVIDER NUMBER |
| 2 | 3K1153 | OTHER | NEW YORK | BLUECROSS PROVIDER NUMBER |
| 3 | 4673219 | OTHER | NEW YORK | AETNA |
| 4 | ========= | OTHER | NEW YORK | CIGNA PROVIDER NUMBER |
| 5 | 216306 | OTHER | NEW YORK | MAGNACARE PROVIDER NUMBER |
| 6 | 3408075 | OTHER | NEW YORK | AETNA PROVIDER NUMBER |
| 7 | 3C3691 | OTHER | NEW YORK | HEALTHNET |
| 8 | P2527966 | OTHER | NEW YORK | OXFORD PROVIDER NUMBER |
| 9 | 2299453 | OTHER | NEW YORK | GHI PROVIDER NUMBER |
| 10 | F46392 | MEDICARE UPIN | NEW YORK | |
| 11 | 2K4851 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE PROVIDER NUMBER |
| 12 | W01981 | MEDICARE PIN | NEW YORK | |
| 13 | 216306 | OTHER | NEW YORK | LICENSE NUMBER |
| 14 | ========= | OTHER | NEW YORK | GREATWEST PROVIDER NUMBER |
| 15 | ========= | OTHER | NEW YORK | UNITED HEALTHCARE PROVIDE |
| 16 | ========= | OTHER | NEW YORK | TAX IDENTIFICATION NUMBER |
| 17 | 189036P | OTHER | NEW YORK | HIP PROVIDER NUMBER |
