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 | 2085R0001X | Radiology | Radiation Oncology | 25MA06318300 | 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 | 65068 | OTHER | NEW JERSEY | AMERIGROUP PROVIDER # |
| 2 | 4099456 | OTHER | NEW JERSEY | GHI PROVIDER NUMBER |
| 3 | 01000343203 | OTHER | NEW JERSEY | AMERICHOICE - WOODBURY # |
| 4 | 60016956 | OTHER | NEW JERSEY | HORIZON NJ HEALTH PROV. # |
| 5 | P00179698 | OTHER | NEW JERSEY | RAILROAD MCARE PROV. # |
| 6 | 2K7309 | OTHER | NEW JERSEY | HEALTH NET PROVIDER # |
| 7 | 3774564 | OTHER | NEW JERSEY | CIGNA PROVIDER NUMBER |
| 8 | P2364047 | OTHER | NEW JERSEY | OXFORD HEALTH PROV. # |
| 9 | 7831005 | MEDICAID | NEW JERSEY | |
| 10 | 0268865000 | OTHER | NEW JERSEY | AMERIHEALTH PROVIDER # |
| 11 | 3644795 | OTHER | NEW JERSEY | AETNA PROVIDER NUMBER |
| 12 | 01000343202 | OTHER | NEW JERSEY | AMERICHOICE - VORHEES # |
| 13 | 01000343204 | OTHER | NEW JERSEY | AMERICHOICE-WILLINGBORO # |
| 14 | 012469THP | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | |
| 15 | 29882 | OTHER | NEW JERSEY | UNIV. HLTH PL. PROVIDER # |
| 16 | G75281 | MEDICARE UPIN | NEW JERSEY | |
