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 | 208000000X | Pediatrics | | 25MA06519800 | NEW JERSEY | No |
| 2 | 2080P0203X | Pediatrics | Pediatric Critical Care Medicine | 213965 | NEW YORK | No |
| 3 | 2080P0203X | Pediatrics | Pediatric Critical Care Medicine | 25MA06519800 | NEW JERSEY | 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 | 02285165 | MEDICAID | NEW YORK | |
| 2 | 0100712-01 | OTHER | NEW YORK | AMERICHOICE |
| 3 | 1000030187 | OTHER | NEW YORK | AFFINITY HEALTH |
| 4 | 135460101 | OTHER | NEW YORK | HEALTH PLUS |
| 5 | 40N0391 | OTHER | NEW YORK | NEIGHBORHOOD HEALTH |
| 6 | 4C4667 | OTHER | NEW YORK | HEALTH NET |
| 7 | 2246605 | OTHER | NEW YORK | UNITED HEALTH CARE |
| 8 | 8Q2301 | OTHER | NEW YORK | EMPIRE BCBS |
| 9 | 213965-A15 | OTHER | NEW YORK | HEALTH FIRST |
| 10 | 0130001 | MEDICAID | NEW JERSEY | |
