Individual provider Active NPI

Tae an Choi, N.P.

  • Adult Health Nurse Practitioner
  • Long Island City, NY
National Provider Identifier
1376831966
Registry record updated Jul 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
305759 Issued in NY
Practice address
3425 Vernon Blvd
Long Island City, NY 11106-5121
Phone
(631) 979-0922
NPI assigned
Jul 15, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 305759 NY Primary

Addresses

Primary practice location

3425 Vernon Blvd
Long Island City, NY 11106-5121

Mailing address

10230 66TH Rd Apt 28C
Forest Hills, NY 11375-7622
Phone (917) 755-6179

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20260127001259 NJ Practitioner - Nurse Practitioner 0749767275 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

523 Park Ave
Orange, NJ 07050-1703

6 Uxbridge Dr
Robbinsville, NJ 08691-4016

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Salerno Medical Associates, LLC CurrentSince Dec 15, 2025 Accepting new patients
Newark Vein and Vascular Center LLC CurrentSince Dec 15, 2025 Accepting new patients
Phoenix Houses of Long Island, Inc. PastSince Jun 1, 2019 Accepting new patients

Locations

613 Park Ave
East Orange, NJ 07017
Phone (973) 672-2455

613 Park Ave
Fl 2
East Orange, NJ 07017
Phone (973) 485-6433

Organizations & group practices 3

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": "1310688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310688000000",
    "number": "1376831966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10230 66TH RD APT 28C",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757622",
            "telephone_number": "917-755-6179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 VERNON BLVD",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111065121",
            "telephone_number": "631-979-0922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOI",
        "first_name": "TAE AN",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-15",
        "last_updated": "2011-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "305759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

Verify at the official NPI Registry.