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 | 207P00000X | Emergency Medicine | | MD021953E | PENNSYLVANIA | No |
| 2 | 207P00000X | Emergency Medicine | | 25MA04322900 | 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 | 07645 | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 2 | 0009543230010 | MEDICAID | PENNSYLVANIA | |
| 3 | 0054318000 | OTHER | PENNSYLVANIA | KEYSTONE IBC |
| 4 | 30048919 | OTHER | NEW JERSEY | KEYSTONE MERCY |
| 5 | 00954323-04 | OTHER | PENNSYLVANIA | AMERICHOICE FRANKFORD |
| 6 | 1437686 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 7 | 126578JL1 | MEDICARE PIN | PENNSYLVANIA | |
| 8 | 582999ZEDB | MEDICARE PIN | NEW JERSEY | |
| 9 | 452729 | OTHER | PENNSYLVANIA | AETNA CONTRACT |
| 10 | 00954323-02 | OTHER | PENNSYLVANIA | AMERICHOICE TORRESDALE |
| 11 | 20045153 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY |
| 12 | 60018877 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 13 | 7970674 | OTHER | PENNSYLVANIA | CIGNA |
| 14 | 0009543230003 | MEDICAID | PENNSYLVANIA | |
| 15 | 00954323-03 | OTHER | PENNSYLVANIA | AMERICHOICE BUCKS |
| 16 | 30021588 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 17 | 582999UKE | MEDICARE PIN | NEW JERSEY | |
| 18 | 1437686 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 19 | 0009543230004 | MEDICAID | PENNSYLVANIA | |
| 20 | P00338388 | MEDICARE PIN | NEW JERSEY | |
| 21 | 0404821000 | OTHER | NEW JERSEY | AMERIHEALTH |
| 22 | 5142504 | MEDICAID | NEW JERSEY | |