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 | 207W00000X | Ophthalmology | | 25MA05315800 | 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 | 10605 | OTHER | NEW JERSEY | CARPENTERS |
| 2 | 1K5324 | OTHER | NEW JERSEY | HEALTH NET |
| 3 | 05278 | OTHER | NEW JERSEY | DAVIS VISION |
| 4 | 0042027000 | OTHER | NEW JERSEY | KEYSTONE HEALTH PLAN EAST |
| 5 | 1138894 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 6 | 000340005 | OTHER | NEW JERSEY | HIGHMARK BLEU SHIELD |
| 7 | 0042027000 | OTHER | NEW JERSEY | AMERIHEALTH NJ |
| 8 | 40248 | OTHER | NEW JERSEY | COLE VISION |
| 9 | 000537359 | OTHER | NEW JERSEY | HIGHMARK BLUE SHIELD |
| 10 | 24329 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLAN |
| 11 | 8103704 | MEDICAID | NEW JERSEY | |
| 12 | 223672457 | OTHER | NEW JERSEY | HORIZON BLUE CROSS/BS |
| 13 | 223672457 | OTHER | NEW JERSEY | USFHP ST VINCENTS MEDICAL |
| 14 | 223672457 | OTHER | NEW JERSEY | QUALCARE |
| 15 | 5478105 | OTHER | NEW JERSEY | AETNA US HEALTH CARE |
| 16 | C400005 | OTHER | NEW JERSEY | AMERIHEALTH ADMINISTRATOR |
| 17 | 10605 | OTHER | NEW JERSEY | SPECTERA VISION PLAN |
| 18 | 180612 | OTHER | NEW JERSEY | UNITED HEALTHCARE |
