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 | 208C00000X | Colon & Rectal Surgery | | 25MA03066400 | 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 | 0489724 | OTHER | NEW JERSEY | AETNA INDIVIDUAL # |
| 2 | 165230 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | MEDICARE GROUP # |
| 3 | B98635 | MEDICARE UPIN | NEW JERSEY | |
| 4 | 067637AUE | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | MEDICARE INDIVIDUAL # |
| 5 | ES563 | OTHER | NEW JERSEY | OXFORD INDIVIDUAL # |
| 6 | 1370296 | OTHER | NEW JERSEY | PHCS # |
| 7 | 0489140 | OTHER | NEW JERSEY | AETNA GROUP # |
| 8 | J30043 | OTHER | NEW JERSEY | HEALTHNET INDIVIDUAL # |
| 9 | 0X00NJ4000 | OTHER | NEW JERSEY | HEALTHNET GROUP # |
| 10 | D09142-SCE402 | OTHER | NEW JERSEY | OXFORD GROUP # |
