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 | 207L00000X | Anesthesiology | | 25MA05324800 | NEW JERSEY | No |
2 | 207L00000X | Anesthesiology | | MD 036934 E | 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 | 1171917 | OTHER | NEW JERSEY | AETNA |
2 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
3 | B34622 | MEDICARE UPIN | PENNSYLVANIA | |
4 | P00069572 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
5 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
6 | 607622RVB | MEDICARE PIN | NEW JERSEY | |
7 | 000060475 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
8 | 50059318 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
9 | 30032895 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
10 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
11 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
12 | 1208926 | MEDICAID | PENNSYLVANIA | |
13 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
14 | 1051606 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
15 | 1124065081 | OTHER | NEW JERSEY | NATIONAL GOVERNMENT SERVICES |
16 | 060475Q1R | MEDICARE PIN | PENNSYLVANIA | |
17 | 0075395000 | OTHER | PENNSYLVANIA | KHPE, AMERIHEALTH, PERSONAL CHOICE |
18 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
19 | 1181515 | OTHER | PENNSYLVANIA | AETNA |
20 | 3690294 | OTHER | PENNSYLVANIA | CIGNA |
21 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
22 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
23 | 060475 | MEDICARE ID-TYPE UNSPECIFIED | | |
24 | 060475GDN | MEDICARE PIN | PENNSYLVANIA | |