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 | 2080A0000X | Pediatrics | Adolescent Medicine | MA070970 | NEW JERSEY | No |
| 2 | 208000000X | Pediatrics | | MA070970 | 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 | 60011030 | OTHER | NEW JERSEY | HORIZON NJ HEALTH PROV. # |
| 2 | K5402 | OTHER | NEW JERSEY | HORIZON BC/BS PROVIDER # |
| 3 | 5845148005 | OTHER | NEW HAMPSHIRE | CIGNA PROVIDER ID # |
| 4 | 2354758001 | OTHER | NEW JERSEY | AMERIHEALTH PROVIDER ID # |
| 5 | 23864 | OTHER | NEW JERSEY | AETNA/USHC HMO PROVIDER # |
| 6 | 2010619 | OTHER | NEW JERSEY | UNITED HEALTH CARE PROV # |
| 7 | 7755130 | OTHER | NEW JERSEY | AETNA/USHC PPO PROVIDER # |
| 8 | 8334200 | OTHER | NEW JERSEY | UNISYS NUMBER |
| 9 | P2068029 | OTHER | NEW JERSEY | OXFORD PROVIDER ID # |
| 10 | 2K5970 | OTHER | NEW JERSEY | HEALTHNET PROVIDER ID # |
| 11 | 89319 | OTHER | NEW HAMPSHIRE | AMERIGROUP PROVIDER ID # |
| 12 | 202119279100 | OTHER | NEW JERSEY | QUALCARE PROVIDER ID # |
