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 | 207LP2900X | Anesthesiology | Pain Medicine | 25MB04990100 | NEW JERSEY | No |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | OS005329L | 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 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 2 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 3 | P00117313 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 4 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 5 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 6 | 0100369000 | OTHER | PENNSYLVANIA | AMERIHEALTH |
| 7 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 8 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 9 | 30026840 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 10 | 435453 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 11 | 50088203 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS-CLINICAL PAIN MANAGMENT |
| 12 | P00125184 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 13 | 1171572 | OTHER | NEW JERSEY | AETNA |
| 14 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 15 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 16 | 23-2919275 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 17 | 1184660474 | OTHER | PENNSYLVANIA | BRAVO |
| 18 | 22-1994560 | OTHER | PENNSYLVANIA | QUALCARE |
| 19 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
| 20 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 21 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 22 | 30009932 | OTHER | PENNSYLVANIA | HORIZON MERCY |
| 23 | 1201983 | OTHER | NEW JERSEY | AETNA |
| 24 | 23-2919275 | OTHER | NEW JERSEY | FIRST MCO |
| 25 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 26 | 23-2919275 | OTHER | PENNSYLVANIA | QUALCARE |
| 27 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 28 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 29 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 30 | 3107710 | OTHER | PENNSYLVANIA | AETNA |
| 31 | 3801579 | OTHER | PENNSYLVANIA | AETNA |
| 32 | 6039566 | OTHER | PENNSYLVANIA | CIGNA |
| 33 | 001966534 | MEDICAID | PENNSYLVANIA | |
| 34 | 0100369000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 35 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 36 | 30026841 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 37 | 435453 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 38 | 50084647 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 39 | 5614434 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |