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 | 207R00000X | Internal Medicine | | 25MA05663900 | 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 | 2591714 | OTHER | NEW JERSEY | GHI |
| 2 | P00139609 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
| 3 | 19999047 | OTHER | NEW JERSEY | LOCAL 734 |
| 4 | 1097281 | OTHER | NEW JERSEY | UNITED HEALTHCARE |
| 5 | MP150 | OTHER | NEW JERSEY | OXFORD |
| 6 | 674418SSX | MEDICARE PIN | NEW JERSEY | |
| 7 | 4320503 | OTHER | NEW JERSEY | AETNA PPO SEA GIRT LOCATI |
| 8 | 4320523 | OTHER | NEW JERSEY | AETNA PPO HOWELL LOCATION |
| 9 | 646801 | OTHER | NEW JERSEY | FIRST HEALTH |
| 10 | 0814303 | OTHER | NEW JERSEY | CIGNA |
| 11 | 3552793 | OTHER | NEW JERSEY | AETNA HMO SEA GIRT LOCATI |
| 12 | 1037553 | MEDICARE UPIN | NEW JERSEY | |
| 13 | 0507767000 | OTHER | NEW JERSEY | AMERIHEALTH NJ |
| 14 | 1046036 | OTHER | NEW JERSEY | HORIZON NJ HEALTH SEAGIRT |
| 15 | 2K5496 | OTHER | NEW JERSEY | HEALTHNET OF THE NORTHEAS |
| 16 | 459337 | OTHER | NEW JERSEY | AETNA HMO HOWELL LOCATION |
| 17 | 5399678 | OTHER | NEW JERSEY | CCN |
| 18 | E87780 | MEDICARE UPIN | NEW JERSEY | |
| 19 | 5098700 | MEDICAID | NEW JERSEY | |
