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 | 2080P0008X | Pediatrics | Neurodevelopmental Disabilities | 25MA06368500 | 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 | 221487148 | OTHER | NEW JERSEY | UNITED HEALTHCARE |
| 2 | 2912448 | OTHER | NEW JERSEY | AETNA HEALTHCARE |
| 3 | 01000767000 | OTHER | NEW JERSEY | AMERICHOICE |
| 4 | 1096732 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 5 | 221487148 | OTHER | NEW JERSEY | DEVON HEALTHCARE |
| 6 | 27446 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLAN |
| 7 | 0294524000 | OTHER | NEW JERSEY | AMERIHEALTH |
| 8 | 2216426 | OTHER | NEW JERSEY | CIGNA BEHAVIORAL HEALTHCA |
| 9 | 42834 | OTHER | NEW JERSEY | AMERIGROUP |
| 10 | S51B01 | OTHER | NEW JERSEY | EMPIRE WELLCHOICE |
| 11 | 17596100 | OTHER | NEW JERSEY | MAGELLAN BEHAVIORAL |
| 12 | 221487148 | OTHER | NEW JERSEY | MULTIPLAN |
| 13 | 221487148 | OTHER | NEW JERSEY | HORIZON BCBS |
| 14 | 221487148-024 | OTHER | NEW JERSEY | QUALCARE INC |
| 15 | 2K3442 | OTHER | NEW JERSEY | HEALTHNET |
| 16 | P2125853 | OTHER | NEW JERSEY | OXFORD HEALTH PLANS |
| 17 | 8252661 | OTHER | NEW JERSEY | CIGNA HEALTHCARE |
