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 | 207RP1001X | Internal Medicine | Pulmonary Disease | MA047793 | 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 | 69D691 | OTHER | NEW JERSEY | EMPIRE BCBS PRIMARY PIN # |
| 2 | 0K2224 | OTHER | NEW JERSEY | HEALTHNET PRIMARY PIN # |
| 3 | C62920 | MEDICARE UPIN | NEW JERSEY | |
| 4 | 196368BT2 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | |
| 5 | BP466 | OTHER | NEW JERSEY | OXFORD PRIMARY PIN # |
| 6 | 11546 | OTHER | NEW JERSEY | AETNA PRIMARY HMO PIN # |
| 7 | 0284106 | MEDICAID | NEW JERSEY | |
| 8 | 2228409630 | OTHER | NEW JERSEY | BCBS PRIMARY PIN # |
| 9 | 5713271 | OTHER | NEW JERSEY | GHI PRIMARY PIN # |
| 10 | 0254989002 | OTHER | NEW HAMPSHIRE | CIGNA PRIMARY PIN # |
| 11 | 2828 | OTHER | NEW JERSEY | AETNA SPECIALIST HMO PIN |
| 12 | 4093545 | OTHER | NEW JERSEY | AETNA PRIMARY PPO PIN # |
