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 | 213EP1101X | Podiatrist | Primary Podiatric Medicine | 25MD00263100 | NEW JERSEY | No |
| 2 | 213ER0200X | Podiatrist | Radiology | 25MD00263100 | NEW JERSEY | No |
| 3 | 213ES0131X | Podiatrist | Foot Surgery | 25MD00263100 | NEW JERSEY | No |
| 4 | 213E00000X | Podiatrist | | 25MD00263100 | 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 | 8569207 | MEDICAID | NEW JERSEY | |
| 2 | 51508 | OTHER | NEW JERSEY | AMERIGROUP |
| 3 | 967806 | OTHER | NEW JERSEY | ONE HEALTH PLAN |
| 4 | 2106180000 | OTHER | NEW JERSEY | AMERIHEALTH |
| 5 | P2525266 | OTHER | NEW JERSEY | OXFORD |
| 6 | 1K8521 | OTHER | NEW JERSEY | HEALTHNET |
| 7 | 38688 | OTHER | NEW JERSEY | MASTERCARE |
| 8 | PG6032 | OTHER | NEW JERSEY | WELL CHOICE |
| 9 | 1147720 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 10 | 2289032 | OTHER | NEW JERSEY | UNITEDHEALTH PLAN |
| 11 | 1953226 | OTHER | NEW JERSEY | FIRST HEALTH |
| 12 | 33046 | OTHER | NEW JERSEY | UNIVERSITY HEALTH PLAN |
| 13 | 85344 | OTHER | NEW JERSEY | OPERATING ENG LOCAL 825 |
| 14 | 8891202002 | OTHER | NEW JERSEY | CIGNA |
