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 | 207W00000X | Ophthalmology | | 25MA06370000 | 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 | 180033572 | OTHER | | RAILROAD MEDICARE |
| 2 | 223589980 | OTHER | | IDA ID NUMBER |
| 3 | 96T25 | OTHER | | EMPIRE BLUE CROSS ID |
| 4 | 223589980 | OTHER | | CORESOURCE ID NUMBER |
| 5 | P1094006 | OTHER | | OXFORD ID NUMBER |
| 6 | 1816887 | OTHER | | UNITED HEALTHCARE ID |
| 7 | 223589980 | OTHER | | BEECH STREET ID NUMBER |
| 8 | 223589980 | OTHER | | NALC ID NUMBER |
| 9 | 0656338 | OTHER | | CIGNA PROVIDER NUMBER |
| 10 | 223589980 | OTHER | | AARP ID NUMBER |
| 11 | OK8636 | OTHER | | HEALTH NET ID NUMBER |
| 12 | 223589980 | OTHER | | PHCS ID NUMBER |
| 13 | 1051800 | OTHER | | AETNA IND PROV NUMBER |
| 14 | 223589980 | OTHER | NEW JERSEY | HORIZON BCBSNJ ID NUMBER |
| 15 | 223589980 | OTHER | | FIRST HEALTH ID NUMBER |
| 16 | 223589980 | OTHER | | MAIL HANDLERS PLAN ID |
| 17 | 7650809 | MEDICAID | NEW JERSEY | |
