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 | 207L00000X | Anesthesiology | | 25MA07258700 | 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 | 1032229 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 2 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 3 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 4 | 199971RVB | MEDICARE PIN | NEW JERSEY | |
| 5 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 6 | 0654243000 | OTHER | PENNSYLVANIA | KHPE, PERSONAL CHOICE, AMERIHEALTH |
| 7 | 745077 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 8 | 745077GDN | MEDICARE PIN | PENNSYLVANIA | |
| 9 | 50085439 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 10 | 7406476 | OTHER | PENNSYLVANIA | CIGNA |
| 11 | 060594RVB | MEDICARE PIN | NEW JERSEY | |
| 12 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 13 | 1916328 | OTHER | NEW JERSEY | AETNA-NJ |
| 14 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
| 15 | 4390492 | OTHER | PENNSYLVANIA | AETNA |
| 16 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 17 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 18 | F57258 | MEDICARE UPIN | NEW JERSEY | |
| 19 | 9076905 | MEDICAID | NEW JERSEY | |
| 20 | 745077 | MEDICARE PIN | PENNSYLVANIA | |
| 21 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS/BLUE SHIELD OF NEW JERSEY |
| 22 | 060594MJZ | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | |
