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 | 261QH0100X | Clinic/Center | Health Service | 70786 | 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 | 097673 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | SBOC(IMAGING, BREAST) |
| 2 | 316700 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | SBOC (OUTPATIENT REHAB) |
| 3 | 001976 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | SBOC(OSTEOPOROSIS CENTER) |
| 4 | 099678 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | SBOC(MULTIPLE SCLEROSIS) |
| 5 | 305438 | MEDICARE OSCAR/CERTIFICATION | NEW JERSEY | |
| 6 | 118521 | MEDICARE OSCAR/CERTIFICATION | NEW JERSEY | |
| 7 | 034222 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | SBOC(SIEGLER CENTER) |
| 8 | 828758 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | SBOC (PAIN INSTITUTE) |
| 9 | 034350 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | SBOC(SPORTS INSTITUTE) |
