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 | 208600000X | Surgery | | 25MA05474800 | NEW JERSEY | No |
| 2 | 208D00000X | General Practice | | 25MA05474800 | NEW JERSEY | No |
| 3 | 207P00000X | Emergency Medicine | | 25MA05474800 | 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 | 449884 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | |
| 2 | 449884UWY | MEDICARE PIN | NEW JERSEY | |
| 3 | 449884UXL | MEDICARE PIN | NEW JERSEY | |
| 4 | 449884UXX | MEDICARE PIN | NEW JERSEY | |
| 5 | 449884 P7D | MEDICARE PIN | NEW JERSEY | |
| 6 | 7025106 | MEDICAID | NEW JERSEY | |
| 7 | 449884NSE | MEDICARE PIN | NEW JERSEY | |
| 8 | 449884P7E | MEDICARE PIN | NEW JERSEY | |
| 9 | F69934 | MEDICARE UPIN | NEW JERSEY | |
| 10 | 449884UWX | MEDICARE PIN | NEW JERSEY | |
| 11 | P00357155 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
| 12 | 449884BE0 | MEDICARE PIN | NEW JERSEY | |
| 13 | 449884AA7 | MEDICARE PIN | NEW JERSEY | |
| 14 | 449884MK3 | MEDICARE PIN | NEW JERSEY | |
| 15 | 449884MK5 | MEDICARE PIN | NEW JERSEY | |
| 16 | 449884CLD | MEDICARE PIN | NEW MEXICO | |
| 17 | 449884 P7F | MEDICARE PIN | NEW JERSEY | |
| 18 | 449884DQM | MEDICARE PIN | NEW JERSEY | |