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 | 208600000X | Surgery | | 25MA06289400 | 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 | P856821 | OTHER | NEW JERSEY | OXFORDHEALTH INC. |
| 2 | 01077777600 | OTHER | NEW JERSEY | AMERICHOICE |
| 3 | 780========= | OTHER | NEW JERSEY | HORIZON BCBS |
| 4 | 1385908 | OTHER | NEW JERSEY | UNITED HEALTHCARE INS. |
| 5 | ========= | OTHER | NEW JERSEY | AARP HEALTHCARE |
| 6 | 1059165 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 7 | ========= | OTHER | NEW JERSEY | CIGNA HEALTHCARE |
| 8 | ========= | OTHER | NEW JERSEY | QUALCARE |
| 9 | 7188005 | MEDICAID | NEW JERSEY | |
| 10 | 0101394 | OTHER | NEW JERSEY | GHI |
| 11 | J13132 | OTHER | NEW JERSEY | ACS HEALTHNET |
| 12 | 72L61 | OTHER | NEW JERSEY | EMPIRE BCBS |
| 13 | 000953156 | OTHER | NEW JERSEY | AMERIHEALTH |
| 14 | 21188 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLANS |
| 15 | 549989 | OTHER | NEW JERSEY | AETNA US HEALTHCARE |
| 16 | 721611 | OTHER | NEW JERSEY | WELLCHOICE |
| 17 | 020041849 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
| 18 | 15603 | OTHER | NEW JERSEY | AMERIGROUP |
| 19 | ========= | OTHER | NEW JERSEY | ST BARNABAS SYSTEM HEALTH |
| 20 | DU953156 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | EMPIRE MEDICARE SERVICES |
