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 | 207U00000X | Nuclear Medicine | | 25MA080873200 | NEW JERSEY | No |
| 2 | 207UN0901X | Nuclear Medicine | Nuclear Cardiology | 25MA08073200 | NEW JERSEY | No |
| 3 | 207UN0902X | Nuclear Medicine | Nuclear Imaging & Therapy | 25MA08073200 | NEW JERSEY | No |
| 4 | 207UN0903X | Nuclear Medicine | In Vivo & In Vitro Nuclear Medicine | 25MA08073200 | NEW JERSEY | No |
| 5 | 2085B0100X | Radiology | Body Imaging | 25MA08073200 | NEW JERSEY | Yes |
| 6 | 2085R0202X | Radiology | Diagnostic Radiology | 25MA08073200 | NEW JERSEY | No |
| 7 | 2085N0700X | Radiology | Neuroradiology | 25MA08073200 | NEW JERSEY | No |
| 8 | 2085N0904X | Radiology | Nuclear Radiology | 25MA08073200 | NEW JERSEY | No |
| 9 | 2085P0229X | Radiology | Pediatric Radiology | 25MA088073200 | NEW JERSEY | No |
| 10 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 25MA08073200 | NEW JERSEY | No |
| 11 | 2085U0001X | Radiology | Diagnostic Ultrasound | 25MA08073200 | NEW JERSEY | No |
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 | 0133299 | MEDICAID | NEW JERSEY | |