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 | 208100000X | Physical Medicine & Rehabilitation | | MA05706900 | 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 | P2681709 | OTHER | | OXFORD HEALTH PLAN NOT IN |
| 2 | 722323 | OTHER | | HORINZON BCBS NJ DIRECT A |
| 3 | 004117179 | OTHER | | FAMILY HEALTH PROV SELECT |
| 4 | 250012005 | OTHER | | RR MEDICARE |
| 5 | G22323 | OTHER | | AMERI ADMIN |
| 6 | 721074 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 7 | 363879700 | OTHER | | DEPT OF LABOR WORKMANS CO |
| 8 | 1K8338 | OTHER | | HEALTHNET HMO PLANS ALSO |
| 9 | 0509463000 | OTHER | | KEYSTONE AMERI BCBS |
| 10 | 722323 | OTHER | | PABS PC |
| 11 | 905513 | OTHER | | FIRSH HEALTH |
| 12 | 363879700 | OTHER | | ACS DOL |
| 13 | F33966 | MEDICARE UPIN | | |
| 14 | 1697844001 | OTHER | | CIGNA |
| 15 | 223671610 | OTHER | | DEVON |
| 16 | 722323 | OTHER | | AMERIHEALTH PC |
| 17 | 2162090 | OTHER | | AETNA IN NETWORK WITH OPE |
