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 | 111N00000X | Chiropractor | | X4365-1 | 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 | 1119494002 | OTHER | NEW YORK | CIGNA |
| 2 | 555513 | OTHER | NEW YORK | AETNA AUSCH DR. NAME |
| 3 | P746592 | OTHER | NEW YORK | OXFORD |
| 4 | 000445141001 | OTHER | NEW YORK | HEALTHNOW (PRISM) |
| 5 | X24831 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE ID |
| 6 | 22-2695629-01 | OTHER | NEW YORK | PRISM |
| 7 | 4470784 | OTHER | NEW YORK | AETNA PPO (DR NAME) |
| 8 | 10086242 | OTHER | NEW YORK | CDPHP |
| 9 | 1C3863 | OTHER | NEW YORK | LANDMARK |
| 10 | 22-2695629 | OTHER | NEW YORK | TAX IDENTIFICATION NUMBER |
| 11 | 0092949 | OTHER | NEW YORK | GHI ALIGNIS |
| 12 | X004365-N01 | OTHER | NEW YORK | HIP |
| 13 | 05000436 SNY01 | OTHER | NEW YORK | ANTHEM HEALTH |
| 14 | 261179200 | OTHER | NEW YORK | FEDERAL WORKERS' COMP |
| 15 | T52823 | MEDICARE UPIN | NEW YORK | |
| 16 | 1513 | OTHER | NEW YORK | AMHC |
| 17 | C04365-5B | OTHER | NEW YORK | IME (WC) |
| 18 | X24831 | OTHER | NEW YORK | BLUE CROSS BLUE SHIELD |
| 19 | 1C8858 | OTHER | NEW YORK | PHS |
| 20 | 76677 | OTHER | NEW YORK | AETNA AUSCH OFFICE ID |
| 21 | X24831 | MEDICARE PIN | NEW YORK | |
