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 | 2080A0000X | Pediatrics | Adolescent Medicine | 25MA06652200 | NEW JERSEY | No |
| 2 | 208000000X | Pediatrics | | 25MA06652200 | 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 | 0650522000 | OTHER | NEW JERSEY | AMERIHEALTH HMO PIN |
| 2 | K4815 | OTHER | NEW JERSEY | HORIZON BCBS HMO PIN |
| 3 | 1K5284 | OTHER | NEW JERSEY | HEALTH NET PIN |
| 4 | 4173951-008 | OTHER | NEW JERSEY | CIGNA PIN |
| 5 | 956005 | OTHER | NEW JERSEY | AMERIHEALTH PPO GROUP ID |
| 6 | 0501095 | OTHER | NEW JERSEY | AETNA HMO GROUP ID |
| 7 | 38823 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLAN ID |
| 8 | 3211463 | OTHER | NEW JERSEY | AETNA HMO PIN |
| 9 | P2173649 | OTHER | NEW JERSEY | OXFORD PIN |
