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 | 208000000X | Pediatrics | | MA076047 | 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 | 0024929 | MEDICAID | NEW JERSEY | |
| 2 | 2222443000 | OTHER | NEW JERSEY | AMERIHEALTH HMO |
| 3 | 1537778 | OTHER | NEW JERSEY | AMERIHEALTH PPO |
| 4 | 7741574/1774288 | OTHER | NEW JERSEY | AETNA US HEALTHCARE |
| 5 | 60023286 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 6 | 36940 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLAN |
| 7 | 010007777 | OTHER | NEW JERSEY | AMERICHOICE |
| 8 | 1107996 | OTHER | NEW JERSEY | AETNA US -HEALTHCARE |
| 9 | 09733 MB5 | MEDICARE PIN | NEW JERSEY | |
| 10 | 1107968 | OTHER | NEW JERSEY | AETNA US-HEALTH CARE |
| 11 | 1537778 | OTHER | NEW JERSEY | PENNSYLVANIA BLUE SHIELD |
| 12 | 3K6024 | OTHER | NEW JERSEY | HEALTHNET, INC |
| 13 | 1932424 | OTHER | NEW JERSEY | UNITED HEALTH CARE |
| 14 | 2248846 | OTHER | NEW JERSEY | CIGNA |
| 15 | A02424 | MEDICARE UPIN | | |
| 16 | P3667478 | OTHER | NEW JERSEY | OXFORD HEALTH PLAN D |
| 17 | 1107989 | OTHER | NEW JERSEY | AENTA US -HEALTHCARE |
