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 | 174400000X | Specialist | | 25MA06505500 | 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 | 7479271 | OTHER | NEW JERSEY | AETNA USHC |
| 2 | 223832708 | OTHER | NEW JERSEY | MAGNA CARE |
| 3 | 64712004 | OTHER | NEW JERSEY | CIGNA |
| 4 | 223832708 | OTHER | NEW JERSEY | BEECH STREET |
| 5 | 223832708 | OTHER | NEW JERSEY | BETTER HEALTH ADVANTAGE |
| 6 | 223832708 | OTHER | NEW JERSEY | ONE HEALTH PLAN |
| 7 | G63573 | MEDICARE UPIN | NEW JERSEY | |
| 8 | 002739 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | |
| 9 | P2555106 | OTHER | NEW JERSEY | OXFORD |
| 10 | 223832708 | OTHER | NEW JERSEY | QUAL CARE |
| 11 | 01000360102 | OTHER | NEW JERSEY | AMERICHOICE |
| 12 | 223832708 | OTHER | NEW JERSEY | NJ CARPENTERS FUND |
| 13 | 010065055NJ01 | OTHER | NEW JERSEY | ANTHEM HEALTH |
| 14 | 0299190 | OTHER | NEW JERSEY | GHI |
| 15 | 2217632 | OTHER | NEW JERSEY | UNITED HEALTH CARE |
| 16 | 223832708 | OTHER | NEW HAMPSHIRE | DEVON |
| 17 | 223832708 | OTHER | NEW JERSEY | CONSUMER HEALTH NETWORK |
| 18 | 223832708 | OTHER | NEW JERSEY | BC/BS |
