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 | 207RN0300X | Internal Medicine | Nephrology | 199878-1 | NEW YORK | No |
| 2 | 207RN0300X | Internal Medicine | Nephrology | 25MA06324000 | 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 | 901398 SJ1 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | INDIVIDUAL NUMBER |
| 2 | 0036536 | MEDICAID | NEW JERSEY | |
| 3 | G56576 | MEDICARE UPIN | NEW JERSEY | |
| 4 | 7378106 | MEDICAID | NEW JERSEY | |
| 5 | DB2462 | OTHER | NEW JERSEY | RAILROAD MEDICARE GROUP # |
| 6 | 043714808 | OTHER | NEW JERSEY | HORIZON B/C B/S |
| 7 | 077061 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | MEDICARE GROUP NUMBER |
| 8 | P00094722 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
| 9 | 01918538 | MEDICAID | NEW YORK | |
