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 | 133V00000X | Dietitian, Registered | | 933910 | NEW JERSEY | No |
| 2 | 207Q00000X | Family Medicine | | 25MA0352770 | NEW JERSEY | No |
| 3 | 207QG0300X | Family Medicine | Geriatric Medicine | 25MA08490600 | NEW JERSEY | No |
| 4 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 25MA09171800 | NEW JERSEY | No |
| 5 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | 25MA08599900 | NEW JERSEY | No |
| 6 | 207RG0100X | Internal Medicine | Gastroenterology | MA062232 | NEW JERSEY | No |
| 7 | 207RN0300X | Internal Medicine | Nephrology | 25MA0497600 | NEW JERSEY | No |
| 8 | 207V00000X | Obstetrics & Gynecology | | 25MA05208400 | NEW JERSEY | No |
| 9 | 207W00000X | Ophthalmology | | 25MA063700000 | NEW JERSEY | No |
| 10 | 208100000X | Physical Medicine & Rehabilitation | | 25MA08540700 | NEW JERSEY | No |
| 11 | 2085R0204X | Radiology | Vascular & Interventional Radiology | MA048966 | NEW JERSEY | No |
| 12 | 363LA2200X | Nurse Practitioner | Adult Health | 26NJ00326000 | NEW JERSEY | No |
| 13 | 207R00000X | Internal Medicine | | 25MA04562300 | 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 | B80065 | MEDICARE UPIN | | |
| 2 | H71110 | MEDICARE UPIN | | |
| 3 | I23235 | MEDICARE UPIN | NEW JERSEY | |
| 4 | 1163604 | MEDICAID | NEW JERSEY | |
| 5 | 26NJ00326000 | OTHER | NEW JERSEY | ADVANCED NURSE PRACTITIONER |
| 6 | C11087 | MEDICARE UPIN | | |
| 7 | D06768 | MEDICARE UPIN | | |
| 8 | G86191 | MEDICARE UPIN | | |
| 9 | 7027508 | MEDICAID | NEW JERSEY | |
| 10 | 11738363 | MEDICARE PIN | | |
| 11 | 135650 | MEDICARE PIN | | |
| 12 | C54156 | MEDICARE UPIN | NEW JERSEY | |
| 13 | U62063 | MEDICARE UPIN | | |
| 14 | 0251623 | MEDICAID | NEW JERSEY | |
| 15 | 131243 | MEDICARE PIN | | |
| 16 | 276193 | MEDICARE PIN | NEW JERSEY | |
| 17 | A60310 | MEDICARE UPIN | | |
| 18 | G06605 | MEDICARE UPIN | | |
| 19 | Q21436 | MEDICARE UPIN | | |
| 20 | 183616 | MEDICARE PIN | NEW JERSEY | |
| 21 | 450539 | MEDICARE PIN | | |
| 22 | 533762 | MEDICARE PIN | | |
| 23 | 578421 | MEDICARE PIN | | |
| 24 | 25MA07920500 | OTHER | NEW JERSEY | MD LICENSE |
| 25 | T91758 | MEDICARE UPIN | | |
| 26 | 7930101 | MEDICAID | NEW JERSEY | |
| 27 | 129699 | MEDICARE PIN | | |
| 28 | 879618 | MEDICARE PIN | | |
| 29 | 25MD00232400 | OTHER | NEW JERSEY | DPM LICENSE |
| 30 | 978514 | OTHER | | CERTIFICATE AMERICAN DIETETIC ASSOCIATION |
| 31 | E39073 | MEDICARE UPIN | | |
| 32 | G13264 | MEDICARE UPIN | | |
| 33 | 0174653 | MEDICAID | NEW JERSEY | |
| 34 | 157336 | MEDICARE PIN | | |
| 35 | 521361 | MEDICARE PIN | NEW JERSEY | |
| 36 | 905724 | MEDICARE PIN | | |
| 37 | C55066 | MEDICARE UPIN | | |
| 38 | 010746 | MEDICARE PIN | NEW JERSEY | |
| 39 | 023282 | MEDICARE PIN | NEW JERSEY | |
| 40 | 162250 | MEDICARE PIN | NEW JERSEY | |
| 41 | 519950 | MEDICARE PIN | NEW JERSEY | |
| 42 | 778225 | MEDICARE PIN | NEW JERSEY | |
| 43 | 7326505 | MEDICAID | NEW JERSEY | |
| 44 | 085392 | MEDICARE PIN | NEW JERSEY | |
| 45 | 445649 | MEDICARE PIN | | |
