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 | 261QR0200X | Clinic/Center | Radiology | 22368 | 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 | 4103497 | OTHER | NEW JERSEY | GHI PIN# |
| 2 | 020769 | MEDICARE PIN | NEW JERSEY | |
| 3 | 1839680 | OTHER | NEW JERSEY | UNITEDHEALTHCARE PIN# |
| 4 | A959624 | OTHER | NEW JERSEY | OXFORD PIN# |
| 5 | 2K6430 | OTHER | NEW JERSEY | HEALTHNET PIN# |
| 6 | 28090922 | OTHER | NEW JERSEY | AETNA PIN# |
| 7 | 1130240V | OTHER | NEW JERSEY | NJ HORIZON MERCY PIN# |
| 8 | 2098369000 | OTHER | NEW JERSEY | AMERIHEALTH PIN# |
| 9 | 8211302 | MEDICAID | NEW JERSEY | |
