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 | 174400000X | Specialist | | 25MA06653900 | NEW JERSEY | No |
| 2 | 207RG0100X | Internal Medicine | Gastroenterology | 76185 | ARIZONA | No |
| 3 | 207RG0100X | Internal Medicine | Gastroenterology | 01083029A | INDIANA | 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 | 1032510700001 | MEDICAID | PENNSYLVANIA | |
| 2 | 5836587 | OTHER | NEW JERSEY | AETNA HMO |
| 3 | 58466 | OTHER | NEW JERSEY | LOCAL 825 PPO |
| 4 | 84713 | OTHER | NEW JERSEY | AMERICAID |
| 5 | 91-000217300 | OTHER | NEW JERSEY | AMERICHOICE |
| 6 | 222233588 | OTHER | NEW JERSEY | AMERICARE |
| 7 | 0007003430001 | OTHER | NEW JERSEY | ONE HEALTH PLAN |
| 8 | 0521635000 | OTHER | NEW JERSEY | AMERIHEALTH HMO |
| 9 | 1066208 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 10 | 919163 | OTHER | NEW JERSEY | AETNA HMO |
| 11 | 9818963-004 | OTHER | NEW JERSEY | CIGNA |
| 12 | 262832 | OTHER | NEW JERSEY | AMERIHEALTH |
| 13 | 1323335 | OTHER | NEW JERSEY | FIRST HEALTH |
| 14 | 149399 | OTHER | NEW JERSEY | CHN |
| 15 | P798256 | OTHER | NEW JERSEY | OXFORD |
| 16 | PO1804107 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 17 | 1K6858 | OTHER | NEW JERSEY | HEALTHNET |
| 18 | 222233588 | OTHER | NEW JERSEY | HORIZON BC/BS |
| 19 | 2499433 | OTHER | NEW HAMPSHIRE | GHI |
| 20 | 559548FLT | OTHER | PENNSYLVANIA | MEDICARE |
| 21 | 7419406 | MEDICAID | NEW JERSEY | |
