Active NPI
Lisa Beth Kogan, P.A.
- Physician Assistant
- Wayne, NJ
National Provider Identifier
1265679708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 25MP00187800
- Practice address
- 145 Route 46 W
Suite 304
Wayne, NJ 07470-6830 - Phone
- (973) 826-8299
- Fax
- (866) 760-4555
- NPI assigned
- Jan 20, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 011406 | NY | |
| Physician Assistant | 363A00000X | 25MP00187800 | NJ | Primary |
Addresses
Primary practice location
145 Route 46 W
Suite 304
Wayne, NJ 07470-6830
Mailing address
145 Route 46 W
Suite 304
Wayne, NJ 07470-6830
Phone (973) 826-8299
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011406 | NY | MD | Mental Health Counselor |
| 25MP00187800 | NJ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1312243200000",
"number": "1265679708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 ROUTE 46 W",
"address_2": "SUITE 304",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074706830",
"telephone_number": "973-826-8299",
"fax_number": "866-760-4555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 ROUTE 46 W",
"address_2": "SUITE 304",
"city": "WAYNE",
"state": "NJ",
"postal_code": "074706830",
"telephone_number": "973-826-8299",
"fax_number": "866-760-4555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOGAN",
"first_name": "LISA",
"middle_name": "BETH",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-20",
"last_updated": "2011-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "011406",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NJ",
"license": "25MP00187800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayne, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.