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 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | MD002566 | 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 | 222747589 | OTHER | NEW JERSEY | EIN |
| 2 | 1194996645 | OTHER | NEW JERSEY | 444 WILLIAMS ST |
| 3 | 1619148160 | OTHER | NEW JERSEY | 516 BERGEN ST |
| 4 | U77847 | MEDICARE UPIN | NEW JERSEY | |
| 5 | 1063683258 | OTHER | NEW JERSEY | 751 BROADWAY |
| 6 | 1548431091 | OTHER | NEW JERSEY | 982 BROAD ST |
| 7 | 1932370483 | OTHER | NEW JERSEY | 101 LUDLOW ST |
| 8 | 1972778413 | OTHER | NEW JERSEY | 1150 SPRINGFIELD AVE |
| 9 | 1235300799 | OTHER | NEW JERSEY | 37 N DAY ST |
| 10 | 1740345693 | OTHER | NEW JERSEY | 741 BROADWAY |
