Active NPI
Andy Wan, DDS
- Dentist
- Bronx, NY
National Provider Identifier
1194019901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 056280
- Practice address
- 4422 Third Avenue
St. Barnabas Hospital/Mills Building - Dental
Bronx, NY 10457 - Phone
- (718) 332-9888
- NPI assigned
- Jun 9, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 056280 | NY | Primary |
Addresses
Primary practice location
4422 Third Avenue
St. Barnabas Hospital/Mills Building - Dental
Bronx, NY 10457
Mailing address
210 Canal St
New York, NY 10013-4155
Phone (212) 385-0001
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056280 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350432000000",
"number": "1194019901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 CANAL ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100134155",
"telephone_number": "212-385-0001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4422 THIRD AVENUE",
"address_2": "ST. BARNABAS HOSPITAL/MILLS BUILDING - DENTAL",
"city": "BRONX",
"state": "NY",
"postal_code": "10457",
"telephone_number": "718-332-9888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAN",
"first_name": "ANDY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-09",
"last_updated": "2012-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "056280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.