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 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | 25MA07120600 | NEW JERSEY | No |
| 2 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | MD421553 | 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 | 5747002 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 2 | 1193693 | OTHER | NEW JERSEY | AETNA |
| 3 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 4 | 10451377 | MEDICAID | PENNSYLVANIA | |
| 5 | 1216431 | OTHER | PENNSYLVANIA | AETNA |
| 6 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMER./HEALTH ASS. |
| 7 | 2306074000 | OTHER | PENNSYLVANIA | KHPE, PERSONAL CHOICE, AMERIHEALTH |
| 8 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 9 | 999308 | OTHER | PENNSYLVANIA | UPMC HEALTH PLAN |
| 10 | 1761794 | OTHER | PENNSYLVANIA | AETNA |
| 11 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 12 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 13 | P00451411 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 14 | P3656794 | OTHER | PENNSYLVANIA | OXFORD |
| 15 | 23-2993867 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 16 | 047057RUZ | MEDICARE PIN | NEW JERSEY | |
| 17 | 50067193 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 18 | 3252773 | OTHER | PENNSYLVANIA | CIGNA |
| 19 | 1630169 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 20 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 21 | 23-2993867 | OTHER | PENNSYLVANIA | DEVON |
| 22 | 23-2993867 | OTHER | PENNSYLVANIA | FIRST MCO |
| 23 | 079277TD9 | MEDICARE PIN | PENNSYLVANIA | |
| 24 | 079277D09 | MEDICARE PIN | PENNSYLVANIA | |
| 25 | C0838608 | OTHER | PENNSYLVANIA | BRAVO |
| 26 | 50062619 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 27 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BCBS OF NJ |
| 28 | 23-2993867 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 29 | 079277 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
| 30 | 079277S8T | MEDICARE PIN | PENNSYLVANIA | |
| 31 | 079277M8W | MEDICARE PIN | PENNSYLVANIA | |
| 32 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 33 | 23-2919275 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 34 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 35 | H34612 | MEDICARE UPIN | PENNSYLVANIA | |