Individual provider Active NPI

Jenson Wacheng Chan

  • Acute Care Nurse Practitioner
  • New York, NY
National Provider Identifier
1205791118
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
F433433 Issued in NY
Practice address
1468 Madison Ave
New York, NY 10029-6508
Phone
(212) 241-6500
NPI assigned
Dec 23, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X F433433 NY Primary

Addresses

Primary practice location

1468 Madison Ave
New York, NY 10029-6508

Mailing address

1420 York Ave Apt 5R
New York, NY 10021-3154
Phone (929) 313-8025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260430001358 NY Practitioner - Nurse Practitioner 4082181763 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

400 Kelby St
FL 9
Fort Lee, NJ 07024-2939

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F433433NYMDAcute Care Nurse Practitioner

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1766448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778025600000",
    "number": "1205791118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 YORK AVE APT 5R",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100213154",
            "telephone_number": "929-313-8025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 MADISON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296508",
            "telephone_number": "212-241-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JENSON",
        "middle_name": "WACHENG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-23",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "F433433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.