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 | 207Q00000X | Family Medicine | | 205232 | NEW YORK | Yes |
| 2 | 207Q00000X | Family Medicine | | OS0007505 | FLORIDA | No |
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 | 05V551 | OTHER | NEW YORK | BLUE CROSS/BLUE SHIELD |
| 2 | 160447 | OTHER | NEW YORK | ELDERPLAN |
| 3 | 05V552 | OTHER | NEW YORK | BLUE CROSS/BLUE SHIELD |
| 4 | 38780A | OTHER | NEW YORK | CIGNA PPO |
| 5 | 131701 | OTHER | NEW YORK | CHN CONSUMER HEALTH NET |
| 6 | 2064925 | OTHER | NEW YORK | AETNA HMO |
| 7 | 58-2388280 | OTHER | NEW YORK | CHOICE CARE HUMANA |
| 8 | TAX ID 58-2388280 | OTHER | NEW YORK | AMER.MEDICAL & LIFE INS. |
| 9 | 040426008913 | OTHER | NEW YORK | FIDELIS CARE |
| 10 | 58-2388280 | OTHER | NEW YORK | DEVON |
| 11 | 98413 | OTHER | NEW YORK | AETNA US HEALTHCARE |
| 12 | 38780A | OTHER | NEW YORK | CIGNA HMO |
| 13 | 58-2388280 | OTHER | NEW YORK | BEECH STREET |
| 14 | 58-2388280 | OTHER | NEW YORK | EMPIRE PLAN |
| 15 | 58-2388280 E69914 | OTHER | NEW YORK | AMERIHEALTH |
| 16 | 040927000056 | OTHER | NEW YORK | FIDELIS CARE |
| 17 | 33565040205232NY01 | OTHER | NEW YORK | ANTHEM HEALTH |
| 18 | 5235644 | OTHER | NEW YORK | AETNA PPO/POS PLAN |
| 19 | DA5232 | OTHER | NEW YORK | ATLANTIS HEALTH PLAN |