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 | | 170715 | 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 | CC0135 | OTHER | NEW YORK | RAILROAD MEDICARE GRP ID |
| 2 | 16535A | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE GROUP ID |
| 3 | 5399027 | OTHER | NEW YORK | GHI PROVIDER ID |
| 4 | 5251333 | OTHER | NEW YORK | AETNA ID |
| 5 | MDC622 | OTHER | NEW YORK | PREFERRED CARE ID |
| 6 | 00020221102 | OTHER | NEW YORK | UNIVERA ID |
| 7 | 058127 | OTHER | NEW YORK | MVP PROVIDER ID |
| 8 | E47354 | MEDICARE UPIN | NEW YORK | |
| 9 | 2222 | OTHER | NEW YORK | BLUE SHIELD GROUP ID |
| 10 | BB2037 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE ID |
| 11 | 01195028 | MEDICAID | NEW YORK | |
| 12 | 000912509001 | OTHER | NEW YORK | BS WNY/HEALTHNOW ID |
| 13 | 170715-7 | OTHER | NEW YORK | WORKERS COMP ID |
| 14 | G0189393590 | OTHER | NEW YORK | BLUE CHOICE GROUP ID |
| 15 | 00372225 | MEDICAID | NEW YORK | |
