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 | 207RI0011X | Internal Medicine | Interventional Cardiology | MA071684 | NEW JERSEY | No |
| 2 | 207RI0011X | Internal Medicine | Interventional Cardiology | 25MA07168400 | 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 | 7307613 | OTHER | NEW JERSEY | AETNA PPO # |
| 2 | 8221517 | OTHER | NEW JERSEY | GHI ID # |
| 3 | P3389564 | OTHER | NEW JERSEY | OXFORD # |
| 4 | 0036331 | MEDICAID | NEW JERSEY | |
| 5 | 01000676400 | OTHER | NEW JERSEY | AMERICHOICE ID # |
| 6 | 2394424000 | OTHER | NEW JERSEY | AMERIHEALTH ID # |
| 7 | 3614421 | OTHER | NEW JERSEY | AETNA HMO # |
| 8 | 612Q13 | OTHER | NEW JERSEY | EMPIRE BC/BS SECAUCUS # |
| 9 | P00174451 | OTHER | NEW JERSEY | RAILROAD MDCR # |
| 10 | 612Q12 | OTHER | NEW JERSEY | EMPIRE BC/BS NEWARK # |
| 11 | 40570 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLANS # |
| 12 | 2K8700 | OTHER | NEW JERSEY | HEALTHNET # |
| 13 | 612Q11 | OTHER | NEW JERSEY | EMPIRE BC/BS GUTTENBERG # |
| 14 | 0036331 | OTHER | NEW JERSEY | MEDICAID ID # |