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 | 207Q00000X | Family Medicine | | 25MA05194300 | NEW JERSEY | No |
| 2 | 207RG0300X | Internal Medicine | Geriatric Medicine | 25MA05194300 | NEW JERSEY | No |
| 3 | 207RS0010X | Internal Medicine | Sports Medicine | 25MA05194300 | NEW JERSEY | No |
| 4 | 2083X0100X | Preventive Medicine | Occupational Medicine | 25MA05194300 | NEW JERSEY | No |
| 5 | 363A00000X | Physician Assistant | | 25MA05194300 | NEW JERSEY | No |
| 6 | 363LP2300X | Nurse Practitioner | Primary Care | 25MA05194300 | NEW JERSEY | No |
| 7 | 207R00000X | Internal Medicine | | 25MA05194300 | NEW JERSEY | Yes |