Individual provider Active NPI

Annie Chan, RN, FNP

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1285036152
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
340246 Issued in NY
Practice address
30 Broad St FL 45
New York, NY 10004-2942
Phone
(212) 530-0630
NPI assigned
Sep 22, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 687127 NY
Family Nurse Practitioner 363LF0000X RN2338100 MA
Family Nurse Practitioner 363LF0000X 340246 NY Primary

Addresses

Primary practice location

30 Broad St FL 45
New York, NY 10004-2942

Mailing address

129 W 29TH St FL 10
New York, NY 10001-5105
Phone (415) 658-6791

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
I20170410001542 NY Practitioner - Nurse Practitioner 5496031270 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
687127NYMDRegistered Nurse
RN2338100MAMDFamily Nurse Practitioner
340246NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Jan 13, 2026 Accepting new patients
Montefiore Medical Center CurrentSince Jan 13, 2026 Accepting new patients
Mount Sinai School of Medicine Past Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

408 W 14th St
Ste 201
New York, NY 10014
Phone (212) 530-0639

919 3rd Ave
Ste 105
New York, NY 10022
Phone (212) 530-0650

680 White Plains Rd
Scarsdale, NY 10583

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707091200000",
    "number": "1285036152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 W 29TH ST FL 10",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015105",
            "telephone_number": "415-658-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 BROAD ST FL 45",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100042942",
            "telephone_number": "212-530-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "ANNIE",
        "credential": "RN, FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-22",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "687127",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN2338100",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "340246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.