NPIMap

Individual provider Active NPI

Omid Zack Javdan, D.O

  • Cardiovascular Disease Physician
  • Manhasset, NY
National Provider Identifier
1649502287
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
263217 Issued in NY
Practice address
800 Community Dr
Manhasset, NY 11030-3822
Phone
(516) 403-9104
Fax
(516) 217-1852
NPI assigned
Feb 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 263217 NY Primary

Addresses

Primary practice location

800 Community Dr
Manhasset, NY 11030-3822

Mailing address

800 Community Dr Ste 206
Manhasset, NY 11030-3821
Phone (516) 403-9104

Other identifiers 1

IdentifierTypeStateIssuer
04504385MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160527000904 NY Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 2163712480 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Complete Medical PCGroup PAC ID 4688069958, 3 clinicians

Practice addresses (Care Compare)

800 Community Dr
Suite 206
Manhasset, NY 11030-3821
Phone (516) 403-9104

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
263217NYMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore Complete Medical PC Cardiovascular Disease CurrentSince Dec 16, 2021 Accepting new patients
New York University Cardiovascular Disease CurrentSince Jun 1, 2015 Accepting new patients
New York University Cardiovascular Disease CurrentSince Jun 1, 2015 Accepting new patients
North Shore University Hospital Past Accepting new patients

Locations

800 Community Dr
Ste 206
Manhasset, NY 11030
Phone (516) 403-9104

300 Community Dr
Manhasset, NY 11030

1155 Northern Blvd
Ste 330
Manhasset, NY 11030
Phone (516) 627-4330

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

Interoperability endpoints

  • Direct secure messaging: ojavdan119966@direct-chsli.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1649502287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 COMMUNITY DR STE 206",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303821",
            "telephone_number": "516-403-9104",
            "fax_number": "516-217-1852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303822",
            "telephone_number": "516-403-9104",
            "fax_number": "516-217-1852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVDAN",
        "first_name": "OMID",
        "middle_name": "ZACK",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-08",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "263217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04504385",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manhasset, NY

Sources for this page

Verify at the official NPI Registry.