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 | 2080A0000X | Pediatrics | Adolescent Medicine | 25MA06821100 | NEW JERSEY | No |
| 2 | 208000000X | Pediatrics | | 25MA06821100 | NEW JERSEY | 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 | 010068211NJ01 | OTHER | NEW JERSEY | ANTHEM HEALTH PIN |
| 2 | 2532962 | OTHER | NEW JERSEY | AETNA HMO PIN |
| 3 | 956005 | OTHER | NEW JERSEY | AMERIHEALTH PPO GRP PIN |
| 4 | 1K7604 | OTHER | NEW JERSEY | HEALTHNET PIN |
| 5 | 606914 | OTHER | NEW JERSEY | PHCS GRP ID |
| 6 | P2075112 | OTHER | NEW JERSEY | OXFORD PIN |
| 7 | 001427892 | OTHER | NEW JERSEY | HIGH MARK PA BLUE SHIELD |
| 8 | 223285437 | OTHER | NEW JERSEY | BEECH ST GRP ID |
| 9 | 0501095 | OTHER | NEW JERSEY | AETNA HMO GRP ID |
| 10 | 2113135000 | OTHER | NEW JERSEY | AMERIHEALTH HMO PIN |
| 11 | 223285437 | OTHER | NEW JERSEY | HCPCS GRP ID |
| 12 | K4810 | OTHER | NEW JERSEY | BCBS MANAGED CARE PIN |
| 13 | 7182328007 | OTHER | NEW JERSEY | CIGNA PIN |
| 14 | 1997280 | OTHER | NEW JERSEY | UNITED HEALTH CARE PIN |
| 15 | 4102R | OTHER | NEW JERSEY | WELL CHOICE PIN |
