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 | 2084P0800X | Psychiatry & Neurology | Psychiatry | 216468-1 | NEW YORK | No |
| 2 | 2084P0800X | Psychiatry & Neurology | Psychiatry | MA070225 | NEW JERSEY | No |
| 3 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | 216468-1 | NEW YORK | No |
| 4 | 246QC1000X | Specialist/Technologist, Pathology | Chemistry | 31D2023238 | NEW JERSEY | No |
| 5 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | MA070225 | NEW JERSEY | No |
| 6 | 101YM0800X | Counselor | Mental Health | MA070225 | NEW JERSEY | No |
| 7 | 101Y00000X | Counselor | | MA070225 | NEW JERSEY | No |
| 8 | 207RA0401X | Internal Medicine | Addiction Medicine | MA070225 | NEW JERSEY | No |
| 9 | 208U00000X | Clinical Pharmacology | | MA070225 | NEW JERSEY | No |
| 10 | 208VP0000X | Pain Medicine | Pain Medicine | MA070225 | NEW JERSEY | No |
| 11 | 207ZP0105X | Pathology | Clinical Pathology/Laboratory Medicine | MA070225 | NEW JERSEY | No |
| 12 | 2084P0802X | Psychiatry & Neurology | Addiction Psychiatry | MA070225 | 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 | H27001 | MEDICARE UPIN | NEW JERSEY | |
| 2 | 0012068 | MEDICAID | NEW JERSEY | |
