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 | 207PP0204X | Emergency Medicine | Pediatric Emergency Medicine | MA72306 | 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 | 8542601 | MEDICAID | NEW JERSEY | |
| 2 | 1602630 | OTHER | NEW JERSEY | AMERIHEALTH PPO/PA BS |
| 3 | 010006263 00 | OTHER | NEW JERSEY | AMERICHOICE |
| 4 | 2281166000 | OTHER | NEW JERSEY | AMERIHEALTH/KEYSTONE/IBC |
| 5 | P3385893 | OTHER | NEW JERSEY | OXFORD |
| 6 | 3500962 | OTHER | NEW JERSEY | AETNA |
| 7 | 1295147 | OTHER | NEW JERSEY | UNITED HEALTH PLAN |
| 8 | 60005776 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 9 | 0537880 | OTHER | NEW JERSEY | CIGNA |
| 10 | 30868 | OTHER | NEW JERSEY | UNIVERISTY HEALTH PLAN |
| 11 | 049170 SZF | MEDICARE PIN | NEW JERSEY | |
| 12 | F49011 | MEDICARE UPIN | | |
