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 | 174400000X | Specialist | | MD051488L | PENNSYLVANIA | No |
| 2 | 207W00000X | Ophthalmology | | MD051488L | PENNSYLVANIA | 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 | 569045 | OTHER | NEW JERSEY | AETNA HMO |
| 2 | 0132145000 | OTHER | NEW JERSEY | KEYSTONE HEALTH PLAN |
| 3 | 0005377005 | OTHER | PENNSYLVANIA | AETNA PPO |
| 4 | 1029889 | OTHER | PENNSYLVANIA | KEYSTONE MERCY HP |
| 5 | 045799 | OTHER | NEW JERSEY | PA BLUE SHIELD |
| 6 | 501249GGA | MEDICARE PIN | PENNSYLVANIA | |
| 7 | 045799DCQ | MEDICARE PIN | NEW JERSEY | |
| 8 | 180022095 | OTHER | PENNSYLVANIA | MEDICARE ID TYPE UNSPECIFIED |
| 9 | A2279 | OTHER | PENNSYLVANIA | MEDICARE ID TYPE UNSPECIFIED |
| 10 | 7900866 | OTHER | PENNSYLVANIA | CIGNA HEALTH PLAN |
| 11 | 10240MD051488L | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 12 | 2227390 | OTHER | NEW JERSEY | UNITED HEALTHCARE |
| 13 | 512352 | OTHER | PENNSYLVANIA | AETNA HMO |
| 14 | F31287 | MEDICARE UPIN | PENNSYLVANIA | |
| 15 | 7064403 | MEDICAID | NEW JERSEY | |
| 16 | 0015305200001 | MEDICAID | PENNSYLVANIA | |
| 17 | 0683538000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN |
| 18 | 0053224000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN |
| 19 | 0132145000 | OTHER | NEW JERSEY | AMERIHEALTH HMO |
| 20 | 0706610000 | OTHER | NEW JERSEY | KEYSTONE HEALTH PLAN |
| 21 | 501249 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |