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 | 207R00000X | Internal Medicine | | | 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 | 0036507 | OTHER | | AETNA HEALTH HMO |
| 2 | 0K4743 | OTHER | | HEALTH NET OF THE NE INC |
| 3 | 82A102 | OTHER | | EMPIRE HEALTHCHOICE INC |
| 4 | 1911201 | MEDICAID | NEW JERSEY | |
| 5 | 82A101 | OTHER | NEW YORK | EMPIRE BC BS OF NY |
| 6 | 82A102 | OTHER | NEW JERSEY | WELLCHOICE HMO OF NJ |
| 7 | 6102397 | OTHER | NEW JERSEY | CIGNA HEALTHCARE OF NJ |
| 8 | 82A101 | OTHER | | EMPIRE HEALTHCHOICE INC |
| 9 | 82A101 | OTHER | | EMPIRE HEALTH PLAN ASSUR |
| 10 | 82A101 | OTHER | NEW JERSEY | WELLCHOICE HMO OF NJ |
| 11 | C52588 | MEDICARE UPIN | | |
| 12 | 041081 | OTHER | | AETNA HEALTH CAPITATION |
| 13 | 82A102 | OTHER | | EMPIRE HEALTH PLAN ASSUR |
| 14 | 82A102 | OTHER | NEW JERSEY | WELLCHOICE INSURANCE |
| 15 | 0K4743 | OTHER | NEW JERSEY | HEALTH NET OF NJ |
| 16 | 82A101 | OTHER | NEW JERSEY | WELLCHOICE INSURANCE |
| 17 | 023545DCH | MEDICARE ID-TYPE UNSPECIFIED | | |
| 18 | 4379743 | OTHER | | AETNA HEALTH TRADITIONAL |
| 19 | 82A102 | OTHER | NEW YORK | EMPIRE BC BS OF NY |
