NPIMap

Individual provider Active NPI

Wen Fan, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • New York, NY
National Provider Identifier
1457499543
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
232248 Issued in NY
Practice address
10 Nathan D Perlman Place
Suite 12S34
New York, NY 10003-3851
Phone
(212) 420-2124
Fax
(212) 420-3449
NPI assigned
Feb 2, 2007
Last updated
Dec 22, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Pathology) Physician 207ZH0000X 232248 NY
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 232248 NY Primary

Addresses

Primary practice location

10 Nathan D Perlman Place
Suite 12S34
New York, NY 10003-3851

Mailing address

1900 Hempstead Tpke
Suite 500
East Meadow, NY 11554-1702
Phone (516) 542-1090

Other identifiers 2

IdentifierTypeStateIssuer
02860346MedicaidNY
3Z11275252OtherNYNGS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070711000155 NY Practitioner - Pathology 9638279359 Reassigns benefits to 2 organizations
I20100929001430 NJ Practitioner - Pathology 9638279359 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gastroenterology Consultants of North Jersey PCGroup PAC ID 4880750066, 3 clinicians
Hudson MD GroupGroup PAC ID 6103240478, 110 clinicians

Practice addresses (Care Compare)

1 Gustave L Levy PL
New York, NY 10029-6504
Phone (212) 241-8014

24 -03 Broadway
Fair Lawn, NJ 07410-3053
Phone (201) 791-7760

401 Pleasant Valley Way
West Orange, NJ 07052-2935
Phone (973) 736-1112

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Anatomic Pathology & Clinical Pathology CurrentSince Apr 1, 2023 Accepting new patients
Valley Physician Services PC CurrentSince Feb 27, 2017 Accepting new patients
Hudson MD Group CurrentSince Jan 8, 2024 Accepting new patients
Gastroenterology Associates of New Jersey, LLC Anatomic Pathology & Clinical Pathology CurrentSince Aug 1, 2016 Accepting new patients
Fpa Hospital Based Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Apr 1, 2023 Accepting new patients
Gastroenterology Consultants of North Jersey PC CurrentSince Jul 26, 2010 Accepting new patients
Fpa Hospital Based CurrentSince Dec 4, 2016 Accepting new patients
Fpa Hospital Based Anatomic Pathology & Clinical Pathology CurrentSince Dec 4, 2016 Accepting new patients
Gastroenterology Medical Associates Past Accepting new patients
David W. Lee MD PA PastSince Feb 6, 2007 Accepting new patients

Locations

24-07 Broadway
#A
Fair Lawn, NJ 07410
Phone (201) 791-7760

1625 Anderson Ave
Ste 204
Fort Lee, NJ 07024
Phone (201) 224-0011

1 Valley Health Plz
Paramus, NJ 07652
Phone (201) 634-5353

140 Chestnut St
Ste 300
Ridgewood, NJ 07450
Phone (201) 444-2600

71 Union Ave
Ste 201
Rutherford, NJ 07070
Phone (201) 842-0020

301 Lakehurst Rd
Toms River, NJ 08755
Phone (732) 281-1590

401 Pleasant Valley Way
West Orange, NJ 07052
Phone (973) 669-5931

401 Pleasant Valley Way
Ste 1
West Orange, NJ 07052
Phone (973) 736-1112

1130 McBride Ave
Fl 3
Woodland Park, NJ 07424
Phone (973) 785-2277

205 Browertown Rd
Woodland Park, NJ 07424
Phone (973) 785-7515

1000 10th Ave
New York, NY 10019
Phone (212) 523-2369

1468 Madison Ave
New York, NY 10029
Phone (212) 241-0440

310 E 14th St
New York, NY 10003
Phone (212) 979-4000

5 E 98th St
Fl 5
New York, NY 10029
Phone (212) 241-8234

5 E 98th St
Fl 6
New York, NY 10029
Phone (212) 241-2221

355 Bard Ave
Staten Island, NY 10310
Phone (718) 818-1380

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DDCBCA/Endpoint/DDCBCA
  • FHIR API: https://fhir4.healow.com/fhir/r4/JJIGAA

Organizations & group practices 11

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1457499543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 HEMPSTEAD TPKE",
            "address_2": "SUITE 500",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115541702",
            "telephone_number": "516-542-1090",
            "fax_number": "770-666-9097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 NATHAN D PERLMAN PLACE",
            "address_2": "SUITE 12S34",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100033851",
            "telephone_number": "212-420-2124",
            "fax_number": "212-420-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "WEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "NY",
            "license": "232248",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "232248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02860346",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NGS",
            "identifier": "3Z11275252",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.