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 | 225100000X | Physical Therapist | | 030904 | NEW YORK | No |
| 2 | 207R00000X | Internal Medicine | | 233906 | 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 | 268SV1 | OTHER | NEW YORK | EMPIRE BLUE CROSS AND BLU |
| 2 | 6C5025 | OTHER | NEW YORK | HEALTHNET |
| 3 | ========= | OTHER | NEW YORK | AETNA |
| 4 | 11P12182 | OTHER | NEW YORK | NY PRESBYTERIAN |
| 5 | 000000119919 | OTHER | NEW YORK | GHI HMO |
| 6 | 179953 | OTHER | NEW YORK | ELDERPLAN |
| 7 | ========= | OTHER | NEW YORK | MULTIPLAN |
| 8 | P3725574 | OTHER | NEW YORK | OXFORD |
| 9 | 233906 | OTHER | NEW YORK | HIP |
| 10 | ========= | OTHER | NEW YORK | GREAT WEST |
| 11 | I21606 | MEDICARE UPIN | NEW YORK | |
| 12 | 07944G | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 13 | 00002513975 09 | OTHER | NEW YORK | UNITED HEALTHCARE |
| 14 | 02619565 | MEDICAID | NEW YORK | |
| 15 | PCP ID# 5416260001 | OTHER | NEW YORK | CIGNA |
| 16 | 000399390201 | OTHER | NEW YORK | HEALTHPLUS |
| 17 | ========= | OTHER | NEW YORK | MAGNACARE |
| 18 | ========= | OTHER | NEW YORK | GHI |
