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 | 208000000X | Pediatrics | | 25MA06442400 | 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 | 1000203000 | OTHER | | AMERICHOICE |
| 2 | 2699163 | OTHER | | GROUP HEALTH INC |
| 3 | 564156 | OTHER | | AETNA HMO |
| 4 | 17658 | OTHER | | UNIVERSITY HEALTH CARE |
| 5 | 1K7910 | OTHER | | PHYSICIANS HEALTH |
| 6 | 1043195 | OTHER | | HORIZON NJ HEALTH |
| 7 | J5528 | OTHER | | BLUE SHIELD NJ HMO |
| 8 | NJ1019 | OTHER | | BLUE SHIELD OF DELAWARE |
| 9 | 5147093 | OTHER | | AETNA MANAGED CARE |
| 10 | 1744624 | OTHER | | UNITED HEALTH CARE |
| 11 | 989964000 | OTHER | | AMERIHEALTH |
| 12 | P402900 | OTHER | | OXFORD HEALTH PLANS |
| 13 | 1325524 | OTHER | | CIGNA |
| 14 | 4131512 | OTHER | | CIGNA |
| 15 | 559261 | OTHER | | BLUE SHIELD OF NEW YORK E |
| 16 | 6976409 | OTHER | | AMERIGROUP |
| 17 | 6976409 | MEDICAID | NEW JERSEY | |
| 18 | 1325524 | OTHER | | FIRST HEALTH GROUP CORP |
