Active NPI
Jeannie Tam
- Pediatrics Physician
- Brooklyn, NY
National Provider Identifier
1053466565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 213626
- Practice address
- 451 Clarkson Ave
Brooklyn, NY 11203-2054 - Phone
- (718) 245-7187
- NPI assigned
- Jan 24, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 213626 | NY | Primary |
Addresses
Primary practice location
451 Clarkson Ave
Brooklyn, NY 11203-2054
Mailing address
123 W 93Rd St
New York, NY 10025-7572
Other practice location 1
1400 Pelham Pkwy S
Bronx, NY 10461-1138
Phone (718) 918-3060
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02271043 | Medicaid | NY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | tamj2@nychhc.org |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
Interoperability endpoints
- jtam1249685@nychhc.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616112000000",
"number": "1053466565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 W 93RD ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100257572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 CLARKSON AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032054",
"telephone_number": "718-245-7187"
}
],
"practiceLocations": [
{
"address_1": "1400 Pelham Pkwy S",
"address_purpose": "LOCATION",
"city": "Bronx",
"state": "NY",
"postal_code": "104611138",
"country_code": "US",
"telephone_number": "718-918-3060",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TAM",
"first_name": "JEANNIE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2021-03-19",
"certification_date": "2021-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "213626",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02271043",
"state": "NY"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "tamj2@nychhc.org",
"affiliation": "N",
"address_1": "451 Clarkson Ave",
"city": "Brooklyn",
"state": "NY",
"country_code": "US",
"postal_code": "112032054",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.