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 | 2080N0001X | Pediatrics | Neonatal-Perinatal Medicine | 25MA07043800 | 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 | P3191505 | OTHER | NEW JERSEY | OXFORD ID # |
| 2 | 178536CY4 | MEDICARE PIN | NEW JERSEY | |
| 3 | 8219773 | OTHER | NEW JERSEY | GHI PPO ID # |
| 4 | 038214 | MEDICARE PIN | NEW JERSEY | |
| 5 | 01000395001 | OTHER | NEW JERSEY | AMERICHOICE ID # |
| 6 | 221494442 | OTHER | NEW JERSEY | TAX ID # |
| 7 | 4453781 | OTHER | NEW JERSEY | AETNA PPO ID # |
| 8 | F69074 | MEDICARE UPIN | NEW JERSEY | |
| 9 | 60011743 | OTHER | NEW JERSEY | HORIZON NJ HEALTH ID # |
| 10 | 86559 | OTHER | NEW JERSEY | AMERICAID ID # |
| 11 | 29404 | OTHER | NEW JERSEY | UNIVERSITY HP ID # |
| 12 | 8226300 | MEDICAID | NEW JERSEY | |
| 13 | 3416781 | OTHER | NEW JERSEY | AETNA HMO ID # |
