Organization Active NPI

Feraydoon Kohan, MD, LLC

  • Cardiovascular Disease Physician
  • Jersey City, NJ
National Provider Identifier
1043310253
Registry record updated Sep 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
25MA06900200 Issued in NJ
Legal business name
FERAYDOON KOHAN, MD, LLC
Practice address
550 Newark Ave
Suite 301a
Jersey City, NJ 07306-1326
Phone
(201) 222-9900
Fax
(201) 222-9929
NPI assigned
Sep 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Feraydoon Kohan, MDNPI 1831134311
Title
President
Phone
(201) 222-9900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X 25MA06900200 NJ Primary

Addresses

Primary practice location

550 Newark Ave
Suite 301a
Jersey City, NJ 07306-1326

Mailing address

PO Box 220035
Great Neck, NY 11022-0035
Phone (201) 222-9900

Other identifiers 1

IdentifierTypeStateIssuer
8763801MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050225000454 NJ Part B Supplier - Clinic/Group Practice 1850344284 Receives reassigned benefits from 1 practitioner
Practice locations: Jersey City, NJ

National Provider Directory

National Provider Directory

Locations

142 Palisade Ave
Ste 209
Jersey City, NJ 07306
Phone (201) 653-8336

550 Newark Ave
Ste 301A
Jersey City, NJ 07306
Phone (201) 533-1002

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1043310253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220035",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110220035",
            "telephone_number": "201-222-9900",
            "fax_number": "201-222-9929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 NEWARK AVE",
            "address_2": "SUITE 301A",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073061326",
            "telephone_number": "201-222-9900",
            "fax_number": "201-222-9929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FERAYDOON KOHAN, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "KOHAN",
        "authorized_official_first_name": "FERAYDOON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-222-9900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA06900200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8763801",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.