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 | | 25MA03556500 | 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 | 1563009 | OTHER | | AMERIGROUP |
| 2 | 1000202900 | OTHER | | AMERICHOICE |
| 3 | 1043193 | OTHER | | HORIZON NJ HEALTH |
| 4 | 2600647 | OTHER | | GROUP HEALTH INC |
| 5 | 78K421 | OTHER | | BS OF NEW YORK EMPIRE |
| 6 | 4131504 | OTHER | | CIGNA |
| 7 | 460129 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 8 | 10913 | OTHER | | AETNA HMO |
| 9 | J5550 | OTHER | | BLUE SHIELD NJ HMO |
| 10 | 158248 | OTHER | | ONE HEALTH PLAN |
| 11 | 1563009 | MEDICAID | NEW JERSEY | |
| 12 | 1315921 | OTHER | | FIRST HEALTH GROUP CORP |
| 13 | F09360 | OTHER | | PHYSICIANS HEALTH |
| 14 | D06693 | MEDICARE UPIN | | |
| 15 | P402784 | OTHER | | OXFORD HEALTH PLANS |
| 16 | NJ1020 | OTHER | | BLUE SHIELD OF DELAWARE |
| 17 | 474351 | OTHER | | UNITED HEALTH CARE |
| 18 | 4060230 | OTHER | | AETNA MANAGED CARE |
