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 | OS-002704L | PENNSYLVANIA | No |
| 2 | 207LA0401X | Anesthesiology | Addiction Medicine | 25MB02315400 | 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 | 1201409 | OTHER | NEW JERSEY | AETNA |
| 2 | 136736 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 3 | 1659993 | OTHER | PENNSYLVANIA | CIGNA |
| 4 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 5 | 000640054 | MEDICAID | PENNSYLVANIA | |
| 6 | 136736 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 7 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 8 | 5738424 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 9 | P00084114 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 10 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 11 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 12 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 13 | 2551644 | OTHER | PENNSYLVANIA | AETNA |
| 14 | 33028C | OTHER | PENNSYLVANIA | HORIZON MERCY |
| 15 | 0022342000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 16 | 22-1994560 | OTHER | PENNSYLVANIA | QUALCARE |
| 17 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
| 18 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 19 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT, INC |
| 20 | 50085446 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 21 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 22 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 23 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 24 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 25 | 23-2919275 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 26 | 33029C | OTHER | PENNSYLVANIA | HORIZON MERCY |
| 27 | 0022342000 | OTHER | PENNSYLVANIA | AMERIHEALTH |
| 28 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 29 | 23-2919275 | OTHER | PENNSYLVANIA | QUALCARE |
| 30 | 1169961 | OTHER | NEW JERSEY | AETNA |
| 31 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 32 | 23-2919275 | OTHER | NEW JERSEY | FIRST MCO |
| 33 | 8194307 | OTHER | PENNSYLVANIA | CIGNA |
| 34 | 1659323699 | OTHER | PENNSYLVANIA | BRAVO HEALTH |
| 35 | 2189116 | OTHER | PENNSYLVANIA | AETNA |
| 36 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT, INC. |
| 37 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
