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 | 207R00000X | Internal Medicine | | MA050972 | 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 | 5187199002 | OTHER | NEW JERSEY | CIGNA HEALTH PLAN |
| 2 | 90000300700 | OTHER | NEW JERSEY | AMERICHOICE |
| 3 | 25MA05097200ANE | OTHER | NEW JERSEY | HEALTHFIRST |
| 4 | C55468 | MEDICARE UPIN | NEW JERSEY | |
| 5 | J6378 | OTHER | NEW JERSEY | HORIZON HMO BLUE PROVIDER |
| 6 | 29EB21 | OTHER | NEW JERSEY | WELL CHOICE PROVIDER NUMB |
| 7 | PP188 | OTHER | NEW JERSEY | OXFORD PROVIDER NUMBER |
| 8 | 595703 | OTHER | NEW JERSEY | AETNA PROVIDER NUMBER |
| 9 | 453471DLQ | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | MEDICARE PROVIDER NUMBER |
| 10 | 511952 | OTHER | NEW JERSEY | UNITED HEALTHCARE |
| 11 | 01095174 | OTHER | NEW JERSEY | AMERIGROUP |
| 12 | 223425594 | OTHER | NEW JERSEY | HORIZON PROVIDER ID NUMBE |
| 13 | 2864054001 | OTHER | NEW JERSEY | AMERIHEALTH |
| 14 | 1658905 | MEDICAID | NEW JERSEY | |
| 15 | 398184 | OTHER | NEW JERSEY | WELLCARE |
| 16 | 713681 | OTHER | NEW JERSEY | HEALTH NET PROVIDER NUMBE |
