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 | 207LP2900X | Anesthesiology | Pain Medicine | 25MB06640800 | NEW JERSEY | No |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | OS008338L | PENNSYLVANIA | 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 | 882973 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 2 | 0042414000 | OTHER | PENNSYLVANIA | AMERIHEALTH |
| 3 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 4 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 5 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 6 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 7 | 059385S8T | MEDICARE PIN | PENNSYLVANIA | |
| 8 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTCARE/OXFORD |
| 9 | 007303RVB | MEDICARE PIN | NEW JERSEY | |
| 10 | 059385Q1R | MEDICARE PIN | PENNSYLVANIA | |
| 11 | 0042414000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 12 | 1416662 | OTHER | NEW JERSEY | AETNA |
| 13 | 23-2919275 | OTHER | PENNSYLVANIA | HELATH AMERICA/HEALTH ASSURANCE |
| 14 | 30036184 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 15 | 23-2919275 | OTHER | NEW JERSEY | FIRST MCO |
| 16 | 059385GDN | MEDICARE PIN | PENNSYLVANIA | |
| 17 | 882973 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 18 | 23-2919275 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 19 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 20 | 7600309 | OTHER | PENNSYLVANIA | CIGNA |
| 21 | 1108366 | OTHER | PENNSYLVANIA | AETNA |
| 22 | 1331762 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 23 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 24 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
| 25 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 26 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 27 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 28 | 23-2919275 | OTHER | PENNSYLVANIA | QUALCARE |
| 29 | 001593217 | MEDICAID | PENNSYLVANIA | |
| 30 | 50059320 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 31 | 1466605 | OTHER | NEW JERSEY | AETNA |
| 32 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTCARE/OXFORD |
| 33 | 050087095 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | RAILROAD |
| 34 | DD1386 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE (GROUP) |
| 35 | DB0435 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE (GROUP) |
| 36 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 37 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 38 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 39 | 22-1994560 | OTHER | PENNSYLVANIA | QUALCARE |
| 40 | G32958 | MEDICARE UPIN | PENNSYLVANIA | |
| 41 | P00134169 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | RAILROAD |
| 42 | 059385 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |