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 | 207R00000X | Internal Medicine | | | | No |
| 2 | 208M00000X | Hospitalist | | | | No |
| 3 | 207R00000X | Internal Medicine | | | 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 | 0736144025 | OTHER | | AMERIHEALTH |
| 2 | 288755 | OTHER | | AETNA |
| 3 | 0736144001 | OTHER | | AMERIHEALTH |
| 4 | 0736144002 | OTHER | | AMERIHEALTH |
| 5 | 0736144003 | OTHER | | AMERIHEALTH |
| 6 | 0736144027 | OTHER | | AMERIHEALTH |
| 7 | 475767 | OTHER | | AETNA - 900 CENTENNIAL BLVD., VOORHEES, NJ |
| 8 | 0736144012 | OTHER | | AMERIHEALTH |
| 9 | 0736144004 | OTHER | | AMERIHEALTH |
| 10 | 3946789 | OTHER | | AETNA - 196 GROVE AVE, THOROFARE, NJ |
| 11 | CA0622 | MEDICARE PIN | NEW JERSEY | |
| 12 | 0736144005 | OTHER | | AMERIHEALTH |
| 13 | 0736144013 | OTHER | | AMERIHEALTH |
| 14 | 0736144029 | OTHER | | AMERIHEALTH |
| 15 | 1153819 | OTHER | | AETNA - 13 TOMLINSON ., MEDFORD, NJ |
| 16 | 6223605 | MEDICAID | NEW JERSEY | |
| 17 | 735993 | OTHER | | AETNA - 1210 BRACE RD., CHERRY HIL, NJ |
| 18 | 115506 | OTHER | | AETNA - 3 COOPER PLAZA, SUITE 215 CAMDEN, NJ |
| 19 | 3626248 | OTHER | | AETNA - 1103 N. KINGS HWY, CHERRY HILL, NJ |
| 20 | 478779 | OTHER | | AETNA - 14 S BROADWAY ,GLOUCESTER, NJ |
| 21 | 0736144000 | OTHER | | AMERIHEALTH |
| 22 | 482284 | OTHER | | AETNA - 1103 NORTH KINGS HWY, CHERRY HILL, NJ |
| 23 | 0736144028 | OTHER | | AMERIHEALTH |
| 24 | 535207 | MEDICARE PIN | NEW JERSEY | |
