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 | 2085B0100X | Radiology | Body Imaging | | NEW JERSEY | No |
| 2 | 2085N0700X | Radiology | Neuroradiology | | NEW JERSEY | No |
| 3 | 2085N0904X | Radiology | Nuclear Radiology | | NEW JERSEY | No |
| 4 | 2085R0202X | Radiology | Diagnostic Radiology | | NEW JERSEY | No |
| 5 | 2085R0205X | Radiology | Radiological Physics | | 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 | 8112304 | MEDICAID | NEW JERSEY | |
| 2 | 1171435 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 3 | 0095270001 | OTHER | NEW JERSEY | AMERIHEALTH |
| 4 | 1943299 | OTHER | NEW JERSEY | UNITED HEALTH CARE |
| 5 | J11285 | OTHER | NEW JERSEY | HEALTH NET |
| 6 | CG5834 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
| 7 | A2021347 | OTHER | NEW JERSEY | OXFORD |
| 8 | WT154 | OTHER | NEW JERSEY | WELLCHOICE |
