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 | 261QP2000X | Clinic/Center | Physical Therapy | 40QA00354600 | 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 | 1272723 | OTHER | NEW JERSEY | FOCUS STRATFORD |
| 2 | 5049064 | OTHER | NEW JERSEY | AETNA |
| 3 | P443885 | OTHER | NEW JERSEY | OXFORD |
| 4 | 912808 | OTHER | NEW JERSEY | KEYSTONE |
| 5 | 0000006637 | OTHER | NEW JERSEY | OPERATING ENGINEERS |
| 6 | 1039682 | OTHER | NEW JERSEY | FIRST HEALTH |
| 7 | ========= | OTHER | NEW JERSEY | HORIZON |
| 8 | A116320 | OTHER | NEW JERSEY | MULTIPLAN SHAPES |
| 9 | 650020404 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | RAILROAD MEDICARE |
| 10 | 5891758 | OTHER | NEW JERSEY | AETNA GROUP |
| 11 | 0816475000 | OTHER | NEW JERSEY | PA BC BS |
| 12 | 451693 | OTHER | NEW JERSEY | AMERIHEALTH |
| 13 | 687802 | OTHER | NEW JERSEY | ACN GROUP UNITED HEALTH |
| 14 | 907797 | OTHER | NEW JERSEY | UNITED HEALTH CARE |
| 15 | 10670461 | OTHER | NEW JERSEY | CAQH |
| 16 | 053770 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | GROUP NUMBER |
| 17 | 21139519023 03 | OTHER | NEW JERSEY | BEECH STREET |
| 18 | A116323 | OTHER | NEW JERSEY | MULTIPLAN STRATFORD |
| 19 | 72001 | OTHER | NEW JERSEY | CIGNA STRATFORD |
| 20 | 72002 | OTHER | NEW JERSEY | CIGNA SHAPES |
