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 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | 139486 | 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 | 6635785002 | OTHER | NEW YORK | CIGNA |
| 2 | 139486 | OTHER | NEW YORK | HIP PROVIDER ID NO |
| 3 | D34148 | MEDICARE UPIN | NEW YORK | |
| 4 | ========= | OTHER | NEW YORK | 1199 PROVIDER ID |
| 5 | 139486 B21 | OTHER | NEW YORK | HEALTHFIRST PROVIDER ID |
| 6 | 67A031 | MEDICARE ID-TYPE UNSPECIFIED | NEW YORK | MEDICARE PROVIDER NO |
| 7 | 0021517 | OTHER | NEW YORK | GHI PROVIDER NO |
| 8 | KS067A0310 | MEDICARE PIN | NEW YORK | |
| 9 | 67A03 | OTHER | NEW YORK | BLUE SHELD PROVIDER NO |
| 10 | P2090111 | OTHER | NEW YORK | OXFORD |
| 11 | 00770576 | MEDICAID | NEW YORK | |
