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 | 2085R0001X | Radiology | Radiation Oncology | OS010834L | PENNSYLVANIA | No |
| 2 | 2085R0001X | Radiology | Radiation Oncology | 25MB07975900 | 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 | 1357771 | OTHER | NEW JERSEY | AETNA |
| 2 | 1900369 | OTHER | PENNSYLVANIA | PENNSYLVANIA BLUE SHIELD |
| 3 | 101175550 0005 | MEDICAID | PENNSYLVANIA | |
| 4 | 2350715000 | OTHER | | KEYSTONE IBC |
| 5 | 30035681 | OTHER | | KEYSTONE MERCY HELATHPLAN |
| 6 | 105059 RHW | MEDICARE PIN | NEW JERSEY | |
| 7 | 010777989 | OTHER | | AMERICHOICE |
| 8 | 2481059 | OTHER | | UNITED HEALTHCARE |
| 9 | 60027459 | OTHER | | HORIZON NJ HEALTH |
| 10 | I13569 | MEDICARE UPIN | | |
| 11 | 082041 | MEDICARE PIN | PENNSYLVANIA | |
| 12 | 3218515 | OTHER | | CIGNA |
| 13 | 1357175 | OTHER | PENNSYLVANIA | AETNA |
| 14 | 2769897000 | OTHER | | AMERIHEALTH |
| 15 | 3K6165 | OTHER | | HEALTHNET |
| 16 | P3722929 | OTHER | | OXFORD |
| 17 | 0054623 | MEDICAID | NEW JERSEY | |
