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 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | MA054808 | NEW JERSEY | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | MD045154E | PENNSYLVANIA | No |
| 3 | 2085R0202X | Radiology | Diagnostic Radiology | MA054808 | NEW JERSEY | No |
| 4 | 2086S0105X | Surgery | Surgery of the Hand | MD045154E | PENNSYLVANIA | No |
| 5 | 2086S0105X | Surgery | Surgery of the Hand | MA054808 | NEW JERSEY | No |
| 6 | 2251H1200X | Physical Therapist | Hand | MD045154E | PENNSYLVANIA | No |
| 7 | 2251H1200X | Physical Therapist | Hand | MA054808 | NEW JERSEY | No |
| 8 | 225XH1200X | Occupational Therapist | Hand | MD045154E | PENNSYLVANIA | No |
| 9 | 225XH1200X | Occupational Therapist | Hand | MA054808 | NEW JERSEY | No |
| 10 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | MD045154E | 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 | F03824 | MEDICARE UPIN | | |
| 2 | 585172 | OTHER | PENNSYLVANIA | PENNSYLVANIA BLUE SHIELD |
| 3 | 200023324 | OTHER | | RAILROAD MEDICARE |
| 4 | 0407110000 | OTHER | PENNSYLVANIA | INDEPENDENCE BLUE CROSS |
| 5 | 585172 | MEDICARE PIN | PENNSYLVANIA | |
