Dr. Reginald O. Coleman M.D. PA

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA03415800 Issued in NJ

Legal business name

DR. REGINALD O. COLEMAN M.D. PA

Practice address

2728 Kennedy Blvd
1St Floor
Jersey City, NJ 07306

Phone

(201) 433-7817

Fax

(201) 433-6044

NPI assigned

Sep 21, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Reginald Oliver Coleman Sr., M.D.

Title

President

Phone

(201) 433-7817

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253491200000",
    "number": "1447584685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2728 KENNEDY BLVD",
            "address_2": "1ST FLOOR",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07306",
            "telephone_number": "201-433-7817",
            "fax_number": "201-433-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2728 KENNEDY BLVD",
            "address_2": "1ST FLOOR",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07306",
            "telephone_number": "201-433-7817",
            "fax_number": "201-433-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. REGINALD O. COLEMAN M.D. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-21",
        "last_updated": "2009-09-21",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_middle_name": "OLIVER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-433-7817",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA03415800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1283405",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.