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 | 174400000X | Specialist | | | | No |
| 2 | 174400000X | Specialist | | | 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 | 045664 PPB | MEDICARE UPIN | NEW JERSEY | |
| 2 | CA4120 | MEDICARE PIN | NEW JERSEY | |
| 3 | 2363616000 | OTHER | NEW JERSEY | AMERIHEALTH (CARDIOLOGY) |
| 4 | 2265447000 | OTHER | NEW JERSEY | AMERIHEALTH (NEUROLOGY) |
| 5 | 045671 PPC | MEDICARE PIN | NEW JERSEY | |
| 6 | 045659 PN9 | MEDICARE PIN | NEW JERSEY | |
| 7 | 3040909 | MEDICAID | NEW JERSEY | |
| 8 | 183652 | MEDICARE PIN | NEW JERSEY | |
| 9 | G01766 | MEDICARE PIN | DELAWARE | |
| 10 | DD9836 | MEDICARE PIN | DELAWARE | |
| 11 | 2206125000 | OTHER | NEW JERSEY | AMERIHLTH (HEMATOLOGY) |
| 12 | 2144779000 | OTHER | NEW JERSEY | AMERIHLTH (CRITICAL CARE) |
| 13 | 045651 PN7 | MEDICARE PIN | NEW JERSEY | |
| 14 | 049041 PW2 | MEDICARE PIN | NEW JERSEY | |
| 15 | 045673 PPD | MEDICARE PIN | NEW JERSEY | |
| 16 | 2277673000 | OTHER | NEW JERSEY | AMERIHLTH (RHEUMATOLOGY |
| 17 | 2233338000 | OTHER | NEW JERSEY | AMERIHEALTH (NEPHROLOGY) |
| 18 | 049097 PXA | MEDICARE PIN | NEW JERSEY | |
| 19 | 045654 PN8 | MEDICARE PIN | NEW JERSEY | |
