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 | 25MA06290400 | NEW JERSEY | No |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | MD051268L | PENNSYLVANIA | 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 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 2 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 3 | 019798 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
| 4 | P00782606 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 5 | 1165420 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 6 | 2180788000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 7 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 8 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 9 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 10 | 1491256 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 11 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 12 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 13 | 777222RUZ | MEDICARE PIN | NEW JERSEY | |
| 14 | 2180788000 | OTHER | PENNSYLVANIA | IBC PRODUCTS |
| 15 | 777222RVB | MEDICARE PIN | NEW JERSEY | |
| 16 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 17 | 1090651 | OTHER | PENNSYLVANIA | AETNA |
| 18 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
| 19 | 23-2919275 | OTHER | NEW JERSEY | FIRST MCO |
| 20 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 21 | G05967 | MEDICARE UPIN | PENNSYLVANIA | |
| 22 | 019798GDN | MEDICARE PIN | PENNSYLVANIA | |
| 23 | 7039869 | OTHER | PENNSYLVANIA | CIGNA |
| 24 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 25 | 0964596 | OTHER | PENNSYLVANIA | AETNA (GROUP) |
| 26 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 27 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 28 | P00089662 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 29 | 1369872 | OTHER | NEW JERSEY | AETNA |
| 30 | 1415441 | OTHER | NEW JERSEY | AETNA |
| 31 | 23-2919275 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 32 | 001555682 | MEDICAID | PENNSYLVANIA | |
| 33 | 019798S8T | MEDICARE PIN | PENNSYLVANIA | |
| 34 | DD1386 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE (GROUP) |
| 35 | 5738457 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 36 | 50059323 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 37 | 1491256 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 38 | P00475878 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE (GROUP DB0435) |
| 39 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 40 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 41 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 42 | 019798Q1R | MEDICARE PIN | PENNSYLVANIA | |
