Active NPI
Jerome Aldrin Enrique Tan
- Physical Therapist
- New York, NY
National Provider Identifier
1487988804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 016103-1
- Practice address
- 4915 Broadway Apt 4P
New York, NY 10034-3162 - Phone
- (917) 669-4304
- NPI assigned
- Oct 1, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 016103-1 | NY | Primary |
Addresses
Primary practice location
4915 Broadway Apt 4P
New York, NY 10034-3162
Mailing address
1 Stokes Rd Apt 2B
Yonkers, NY 10710-5941
Phone (914) 202-7708
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 |
|---|---|---|---|
| 016103-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254355200000",
"number": "1487988804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 STOKES RD APT 2B",
"city": "YONKERS",
"state": "NY",
"postal_code": "107105941",
"telephone_number": "914-202-7708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4915 BROADWAY APT 4P",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100343162",
"telephone_number": "917-669-4304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "JEROME ALDRIN",
"middle_name": "ENRIQUE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-01",
"last_updated": "2009-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "016103-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.