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 | 207RG0100X | Internal Medicine | Gastroenterology | MA68756 | NEW JERSEY | Yes |
| 2 | 207RG0100X | Internal Medicine | Gastroenterology | MD067373L | PENNSYLVANIA | No |
| 3 | 207RG0100X | Internal Medicine | Gastroenterology | MD4521 | DELAWARE | No |
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 | 0273472000 | OTHER | NEW MEXICO | AMERIHEALTH HMO |
| 2 | 223266219 | OTHER | NEW JERSEY | CONVENTRY HEALTH PLAN |
| 3 | 26245 | OTHER | NEW JERSEY | CHRISITIANA CARE HEALTH PLAN |
| 4 | 3644352 | OTHER | NEW JERSEY | AETNA US HEALTHCARE |
| 5 | 8039801 | MEDICAID | NEW JERSEY | |
| 6 | 1000034278 | OTHER | DELAWARE | DELAWARE MEDICAID |
| 7 | 1682129 | OTHER | DELAWARE | AMERIHEALTH PPO OF DELAWARE |
| 8 | 1K6918 | OTHER | NEW JERSEY | HEALTHNET, INC |
| 9 | 100015835 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
| 10 | 1104170 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 11 | 2355748000 | OTHER | DELAWARE | AMERIHEALTH HMO OF DELAWARE |
| 12 | 540720 | OTHER | NEW JERSEY | AMERIHEALTH PPO PABS |
| 13 | 010003876 00 | OTHER | NEW JERSEY | AMERICHOICE |
| 14 | 2184185 | OTHER | NEW JERSEY | AETNA US HEALTH CARE |
| 15 | 24668 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLAN |
| 16 | G01766C02 | OTHER | DELAWARE | DELAWARE MEDICARE |
| 17 | P1950223 | OTHER | NEW JERSEY | OXFORD UNITED |
| 18 | 1952022 | OTHER | NEW JERSEY | UNITED HEALTHCARE |
| 19 | 9291506 | OTHER | NEW JERSEY | CIGNA |
