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 | 2085R0001X | Radiology | Radiation Oncology | 154290 | 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 | 0034642 | OTHER | NEW YORK | GHI |
| 2 | 15D911 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | |
| 3 | 10038783 | OTHER | NEW YORK | CDPHP |
| 4 | 000470811002 | OTHER | NEW YORK | BCBS NE NY |
| 5 | 13261 | OTHER | NEW YORK | GHI |
| 6 | P2548529 | OTHER | NEW YORK | OXFORD FREEDOM |
| 7 | 9567121 | OTHER | NEW YORK | GHI PPO |
| 8 | 15D911 | OTHER | NEW YORK | EMPIRE BCBS |
| 9 | 397114 | OTHER | NEW YORK | MVP |
| 10 | 2329614 | OTHER | NEW YORK | AETNA USHC HMO |
| 11 | A60763 | MEDICARE UPIN | NEW YORK | |
| 12 | P2548529 | OTHER | NEW YORK | OXFORD LIBERTY |
| 13 | 0885566 | OTHER | NEW YORK | AETNA USHC |
| 14 | 000478081002 | OTHER | NEW YORK | BCBS NE NY |
| 15 | 930711 | OTHER | NEW YORK | EMPIRE BCBS |
| 16 | 4336394 | OTHER | NEW YORK | AETNA USHC PPO |
| 17 | 397001 | OTHER | NEW YORK | MVP |
| 18 | 00824153 | MEDICAID | NEW YORK | |
