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 | 213E00000X | Podiatrist | | SC001621L | PENNSYLVANIA | No |
| 2 | 213E00000X | Podiatrist | | 25MD00101100 | 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 | F14282 | OTHER | | HEALTH NET |
| 2 | ME0000076-00 | OTHER | NEW JERSEY | AMERICHOICE OF NJ |
| 3 | 1290703 | MEDICAID | NEW JERSEY | |
| 4 | 0000145043 | MEDICARE NSC | PENNSYLVANIA | |
| 5 | 00506066-04 | OTHER | PENNSYLVANIA | AMERICHOICE OF PA |
| 6 | 208038000 | OTHER | | US DEPT OF LABOR |
| 7 | JS202 | OTHER | | OXFORD INSURANCE |
| 8 | 0060695000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 9 | T72889 | MEDICARE UPIN | | |
| 10 | 0009785 | OTHER | | GROUP HEALTH INSURANCE |
| 11 | 1082520 | OTHER | NEW JERSEY | HORIZON INSURANCE |
| 12 | 15115 | OTHER | | UNIVERSITY HEALTH PLAN |
| 13 | 14959 | OTHER | NEW JERSEY | AMERIGROUP OF NJ |
| 14 | 0000571097 | MEDICARE NSC | NEW JERSEY | |
| 15 | 145043FHA | MEDICARE PIN | PENNSYLVANIA | |
| 16 | 571097AL1 | MEDICARE PIN | NEW JERSEY | |
| 17 | 0392528000 | OTHER | NEW JERSEY | AMERIHEALTH OF NJ |
| 18 | 2314788 | OTHER | | AETNA |
| 19 | 480010991 | OTHER | | RAILROAD MEDICARE |
